Background: With a trend towards greater virtual care in selected clinical settings, perioperative anticoagulant management appears well-suited for this care delivery model. We explored the potential for virtual care among patients who are receiving anticoagulant therapy and require perioperative management around the time of an elective surgery/procedure.
Methods: We undertook a retrospective review of patients who were receiving anticoagulant therapy, either a direct oral anticoagulant (DOAC) or warfarin, assessed in a perioperative anticoagulation-bridging clinic over a 5-year period of 2016 to 2020. Using prespecified criteria, we determined the proportion of patients who likely would be suitable for virtual care (receiving a DOAC or warfarin and having a minimal- or low/moderate-bleed-risk surgery/procedure), those who likely would be suitable for in-person care (receiving warfarin and requiring heparin bridging for a mechanical heart valve), and patients who would be suitable for either care delivery models (receiving a DOAC or warfarin, but not with a mechanical heart valve, and requiring a high-bleed-risk surgery/procedure).
Results: During the 5-year study period, there were 4,624 patients assessed for perioperative anticoagulant management in whom the most widely used anticoagulants were warfarin (37%), apixaban (30%) and rivaroxaban (24%). Within each year assessed, 4-20% were undergoing a minimal bleed-risk procedure, 76-82% of all patients were undergoing a low/moderate-bleed-risk surgery/procedure, and 10-39% were undergoing a high-bleed-risk surgery/procedure. The proportion of patients considered suitable for virtual, in-person, or either virtual or in-person management was 81.8%, 5.0%, and 13.2%, respectively.
Conclusion: In patients who were assessed in a perioperative anticoagulation clinic, there is a high proportion of patients in whom a virtual care model might be suitable.