Impact of Oral Direct Thrombin Inhibitors on Anticoagulation Clinics

Abstract

The advent of oral DTIs is likely to have a significant impact on the structure and delivery of antithrombotic services. Clinics that are proactive and redesign their patient care services to consider emerging anticoagulant agents will be more likely to remain relevant and viable.

Anticoagulation Management Services: Entering a New Era

“…6,7 Although the beneficial impact and value of pharmacist-managed anticoagulation clinics have been documented in the literature, data have been lacking to directly compare outcomes in anticoagulation clinics managed by various health providers and specialties (e.g., nurses vs pharmacists). Thus, consensus on the most effective anticoagulation clinic organizational structure and staffing model is lacking.…”

“…2,6,7,13 Many new oral anticoagulants are now in late-phase clinical development, with some even approved in Canada and Europe, and the introduction of these agents to the United States in the near future will have a significant impact on anticoagulation clinics and on daily clinical practice. 14 The oral anticoagulants that are closest to market introduction in the United States are the direct factor-Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran.…”

“…A survey of U.S.-based anticoagulation providers indicated a 55% projected drop in patient volume in anticoagulation clinics after the introduction of novel oral anticoagulants. 7 The survey also predicted a 59% decline in laboratory-related drug monitoring and management activities. Most anticoagulation providers also felt that the introduction of the new oral anticoagulants will have a moderate-tosignificant impact on the scope of their clinical activities and may jeopardize the financial viability of their service.…”

“…Most anticoagulation providers also felt that the introduction of the new oral anticoagulants will have a moderate-tosignificant impact on the scope of their clinical activities and may jeopardize the financial viability of their service. 7 Thus, the introduction of novel oral anticoagulants will present both an opportunity and a threat.…”

“…2,6,7,13,15,16 It is expected that the anticoagulation clinics of the future will be retooling and broadening the scope of their services to include management of novel antithrombotic agents. Provision of coordinated care management anticoagulation models for existing anticoagulants has been endorsed by the National Quality Forum 4 in conjunction with the Agency for Healthcare Research and Quality 17 as one of 30 National Safe Practices for Better Health Care.…”