Implementation and Preliminary Clinical Outcomes of a Pharmacist‐managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge

Abstract

Abstract:Objective. To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider.Interventions. Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider. Pharmacists in the VTE clinic work independently under a collaborative practice agreement. An evaluation of thirty-four patients, seventeen in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a primary care provider.Results. The primary endpoint was a six month composite of anticoagulation treatmentrelated complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication Accepted ArticleThis article is protected by copyright. All rights reserved.adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p=1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in 8 patients in the pharmacist group versus 0 patients in the control group. No differences were seen amongst other secondary endpoints.Conclusions. The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting.The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a collaborative practice agreement may be as safe as care by a primary care provider. Introduction:

Evaluation of Remote Pharmacist-Led Outpatient Service for Geriatric Patients on Rivaroxaban for Nonvalvular Atrial Fibrillation During the COVID-19 Pandemic

“…results enriched the reported literature on the impact of clinical pharmacist care on individual components of anticoagulation therapy (Ashjian et al, 2017;DiRenzo et al, 2018). This study indicated that as part of the healthcare provider team, pharmacists are well-positioned to provide motivational advice and patient counseling to promote patient understanding of anticoagulation therapy, patient awareness of potential adverse events, and the importance of medication adherence during the epidemic period.…”

Systematic Review of Real-World Studies Evaluating Characteristics Associated With or Programs Designed to Facilitate Outpatient Management of Deep Vein Thrombosis

“…This left 21 real-world studies evaluating clinical characteristics associated with or programs designed to facilitate outpatient DVT treatment to be included in our systematic review (Table 1). 4,8 -10,14 -37…”

“…Of the studies of programs aimed at facilitating outpatient treatment of acute DVT for patients presenting to the ED identified in our systematic review, one (Beam and colleagues) reported outcomes among outpatients (n = 71) that were prospectively followed for ∼1 year (mean = 389 days) after their acute DVT. 8-9,35 -37 None of these patients had recurrent VTE or major bleeding while receiving DOAC therapy. Decreased costs and favorable health-related quality of life scores have also been reported among patients selected for outpatient treatment using the criteria described by Beam and colleagues.…”

“…Decreased costs and favorable health-related quality of life scores have also been reported among patients selected for outpatient treatment using the criteria described by Beam and colleagues. 8-9,35 -37 In a case–control study, treatment costs were compared between patients receiving outpatient treatment with a DOAC (ie, cases) and 47 controls treated with initial LMWH and a VKA following an acute VTE. 8 At 6 months, median VTE-related treatment costs were US$1446 (interquartile range [IQR] = US$1143-US$2842) for patients receiving a DOAC versus US$4006 (IQR = US$2692-US$8476) in the control group ( P < .001).…”

“…52 At 3 to 6 months, VEINES QoL scores increased to 73 ± 7 ( P < .001), while PCS scores increased to 42.2 ± 12.9 ( P < .05). 35 Although this program designed by Beam and colleagues resulted in favorable outcomes, 8-9,35 -37 whether similar programs will increase the proportion of patients with acute DVT that can be safely managed as outpatients has yet to be determined.…”