Evaluation of a pharmacist-led outpatient direct oral anticoagulant service

Ashjian, Emily; Kurtz, Brian P.; Renner, Elizabeth; Yeshe, Robert; Barnes, Geoffrey D.

doi:10.2146/ajhp151026

Cited by 39 publications

(53 citation statements)

References 8 publications

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“…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.…”

Section: Discussionsupporting

confidence: 52%

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

Zuo

Lü

et al. 2020

Front. Pharmacol.

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Objective: This study was designed to evaluate the efficacy of remote medication management of rivaroxaban by pharmacists for geriatric patients with nonvalvular atrial fibrillation during the COVID-19 pandemic. Methods: A single-site, prospective cohort study was conducted among patients with non-valvular atrial fibrillation who received rivaroxaban therapy from July 2019 to December 2019. Patients in the pharmacist-led education and follow-up service (PEFS) group were managed remotely by a pharmacist. In contrast, those in the usual care (UC) group were managed by other providers. Data of routine blood tests, coagulation function tests, which also included cardiac function parameters were collected. The number and type of provider encounters, interventions related to rivaroxaban therapy, the occurrence of thromboembolism or bleeding, and the time of the first outpatient visit after discharge were recorded. Results: A total of 600 patients were recruited, and results of 381 patients were analyzed in the end, of which 179 patients were from the PEFS group and 202 were from the UC group. There was no significant difference between the two groups in terms of the occurrence ratio of systemic thrombosis, heart failure (LVEF < 40%), and left atrial dilation, which was defined as enlargement of left atrial diameter (LAD) > 40 mm. The cumulative incidences of bleeding complications, such as gastrointestinal tract and skin ecchymosis, were significantly higher in the UC group (12.4% vs. 6.1%, P=0.038; 4.5% vs. 0.6%, P=0.018). There was no significant difference after pharmacist intervention in terms of thrombosis occurrence ratio between the two groups (P = 0.338, HR: 0.722, 95% CI: 0.372-1.405). Remote instruction by a pharmacist reduced outpatient service frequency within the first 30 days after discharge (23.7% vs. 1.1%, P < 0.001). However, more patients in the PEFS group presented for the first outpatient revisit later than 40 days postdischarge (12.8% vs. 21.3%, P < 0.001).

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Section: Discussionsupporting

confidence: 52%

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

Zuo

Lü

et al. 2020

Front. Pharmacol.

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“…Eighty‐five percent of pharmacists responded that they participate in the evaluation or discussion of patients on DOACs in the pre‐transplant period. Pharmacist involvement in outpatient DOAC management leads to improved appropriate DOAC dosing and medication adherence, highlighting the role of pharmacist monitoring in these patients 24 …”

Section: Discussionmentioning

confidence: 99%

Utilization of direct‐acting oral anticoagulation in solid organ transplant patients: A national survey of institutional practices

Lichvar

Pierce

Salerno

et al. 2020

Clinical Transplantation

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The safety and efficacy of direct‐acting oral anticoagulants (DOACs) and reversal strategies are not well established in the solid organ transplant population. This was a survey of pharmacists to assess DOAC and urgent reversal practices among adult transplant programs in the United States. A 27‐question survey was distributed to members of transplant pharmacy organization listservs between 5/28/19 and 6/30/19. A total of 115 responses were received from kidney (43.5%), heart (20.0%), lung (18.3%), liver (13.9%), and pancreas (4.4%) transplant programs. DOAC use prior to transplant was mostly prohibited in thoracic programs (77.3%) but more permissive in kidney transplant programs (64.0%). If permitted, apixaban (57.8%) was most preferred. At transplant surgery, reversal of DOAC was performed “as needed” (20.9%) or was not routine (18.3%). DOAC use post‐transplant was more permissive (94.3%). A majority of responders follow FDA recommended dosing in the setting of drug‐drug interactions (51.1%). Major factors influencing DOAC prescribing decisions included renal function, drug‐drug interactions, and insurance. High clinical practice variability exists regarding DOAC utilization and urgent reversal strategies in pre‐, peri‐, and post‐transplant stages. While more research is needed to refine the clinical landscape, many institutions are using DOAC therapy under the perception that they pose a similar risk of bleeding compared to a non‐transplant population.

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“…9 More recently, a retrospective analysis of all DOACs prescription within the University of Michigan Health System found that pharmacistled DOACs service increased appropriate dosing, follow-up, and patient adherence to DOACs. 7 Since the introduction of DOACs to the market, anticoagulation management has encountered significant changes. Current practice guidelines such as CHEST guidelines suggest DOACs over warfarin in both non-valvular atrial fibrillation and noncancer venous thromboembolism patients.…”

Section: Introductionmentioning

confidence: 99%

Assessing Pharmacists Knowledge and Attitude Toward the Direct Oral Anticoagulants in Qatar

El-Bardissy

Elewa

Khalil

et al. 2020

Clin Appl Thromb Hemost

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Pharmacists were found to play a key role in anticoagulation care. In order to make an appropriate selection and counselling regarding direct oral anticoagulants (DOACs), pharmacists should be knowledgeable and abiding by evidence-based practice. We aim in this study to assess the knowledge and practices of practicing hospital and community pharmacists in Qatar regarding DOACs and their reflection on the dispensing and patient education. A prospective cross-sectional survey was developed. It included questions on demographic and professional characteristics. Additionally, it evaluated the awareness regarding safety, efficacy, and dispensing of DOACs. Lastly, a separate question was used to address the participant’s satisfaction with their knowledge. A total response were received from 211 pharmacists participating in the survey. Overall awareness score was moderate (41.6% ± 26%). These scores were in alignment with participants’ self-satisfaction with knowledge on DOACs (72% of participants were not satisfied). Being a clinical pharmacist, of male gender, and with a board certification were factors associated with increased awareness on DOACs. Results from this survey point to the importance of having more educational activities in order to improve pharmacist’s knowledge of DOACs.

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Evaluation of a pharmacist-led outpatient direct oral anticoagulant service

Abstract: A pharmacist-led DOAC service increased appropriate dosing of DOACs at baseline and follow up as well as patient adherence to therapy.

Cited by 39 publications

References 8 publications

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

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

Utilization of direct‐acting oral anticoagulation in solid organ transplant patients: A national survey of institutional practices

Assessing Pharmacists Knowledge and Attitude Toward the Direct Oral Anticoagulants in Qatar

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