Development of an Anticoagulation Stewardship Program at a Large Tertiary Care Academic Institution

Abstract

Pharmacist-directed anticoagulation management services (AMSs) have been shown to significantly lower anticoagulation-related mortality, length of hospital stay, bleeding complications, blood transfusion requirements, and cost of therapy. AMSs are only 1 component of an anticoagulation stewardship program. Frequently, stewardship programs are limited to inpatient populations. Incorporating components that facilitate transition to outpatient status will ideally encompass complete care. The purpose of this program was to expand anticoagulation services and standardize care by implementing a full-service stewardship program including a transition of care service. The first component of the study involved medication surveillance for inpatients on anticoagulation therapy. The second component involved transitioning patients on anticoagulation, primarily with venous thromboembolism (VTE) to outpatient management. Finally, the pharmacist identified areas for optimization. Optimization involved developing or updating protocols to reflect updates in the literature as well as updating institution-specific information resources. Interventions made through medication surveillance and utilization of the VTE transition of care services translated into a total cost savings of approximately US$270 320. A postgraduate, first-year pharmacy resident contributed to improving patient outcomes while reducing utilization of hospital services and obtaining substantial cost savings through participation in anticoagulation stewardship services.

Effect of Standardized Warfarin Treatment Protocol on Anticoagulant Effect: Comparison of a Warfarin Medication Therapy Adherence Clinic with Usual Medical Care

“…The study also reported that more patients in the traditional physician-monitored group had sub-therapeutic INR measurement ≤1.5 and they did not return as quickly for dosage adjustment ( Poon et al, 2007 ). In addition, a prospective study by Padron and Miyares (2013) carried out in the Jackson Memorial Hospital, Miami, reported that involvement of pharmacists in anticoagulation management can enhance standards of care and ensure the protocols were upheld, therefore improving patients’ outcomes.…”

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

“…Twenty studies evaluated targeted drug programs (Table S3). The majority of these evaluations utilized study designs at high risk of bias. Nonrandomized posttest designs with a historical control comprised 55% studies, followed by single‐group posttest (15%), single‐group pretest‐posttest (10%), and nonrandomized pretest‐posttest with a historical control (5%).…”

Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol

“…In one survey sent to members of the America College of Pharmacists practice and research networks for cardiology, critical care and general internal medicine, only 4 of 25 responding member centres indicated that their antithrombotic service was multidisciplinary 7. Padron and Miyares8 describe an expanded antithrombotic stewardship, including both DOAC treatment and facilitating care after hospital discharge. It concerned a US single-centre pharmacist-directed stewardship.…”

“…Interventions consisted of changes to a more appropriate antithrombotic therapy according to guidelines and dosing corrections. The length of hospital stay was reduced by 1.5 days and cost-savings were $270.320 ($661 per patient) in 1.5 years 8. Tedders and colleagues evaluated the impact of an inpatient, pharmacist-led dabigatran management protocol.…”