Implementation of warfarin to direct oral anticoagulant conversion initiative in pharmacist‐run anticoagulation clinics during COVID‐19 pandemic

Kish, Kaitlin; Lekic, Sanela

doi:10.1002/jac5.1470

Cited by 6 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As noted, zero patients switched from a DOAC back to warfarin because of cost when DOAC adherence/persistence was assessed after one year. Another study reported patients’ reluctance to transition to a DOAC was an unexpected challenge, 5 which we also noted during our study as we had 23 patients (7.5%) who were either not interested or hesitant to switch.…”

Section: Discussionsupporting

confidence: 66%

“…One study described implementation of a warfarin to DOAC conversion initiative in pharmacist-run anticoagulation clinics during the COVID-19 pandemic, but unfortunately did not report percentages of patients who were deemed to be candidates for DOACs or how many were switched to DOACs. 5 Therefore, our study aimed to describe not only the process used to assess for potential conversion from warfarin to DOACs, but also the number of patients who were transitioned during the COVID-19 pandemic and remained on a DOAC after one year.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of a Pharmacist-Led Warfarin to Direct Oral Anticoagulant Conversion Initiative during the COVID-19 Pandemic

et al. 2022

View full text Add to dashboard Cite

Purpose: To assess the impact of a pharmacist-led warfarin to DOAC conversion initiative during the COVID-19 pandemic. Methods: Patients who were prescribed warfarin and followed with the anticoagulation clinic for INR monitoring were assessed by outpatient clinical pharmacists as potential candidates for transition to DOACs from March-August 2020. Results: 530 patients were assessed for transition to DOACs, of which 373 (70.4%) were deemed by clinical pharmacists to be candidates for DOACs. Of the patients who were candidates for DOACs, 66 (17.7%) were transitioned from warfarin to a DOAC. Of the patients who transitioned to a DOAC, 59 (89.4%) remained on a DOAC after one year. Conclusion: Outpatient clinical pharmacists are an effective resource to help identify patients who are candidates for DOACs and assist with transition from warfarin. Further, high persistence rates with DOAC therapy after one year demonstrate the positive impact of the clinical pharmacist on medication adherence.

show abstract

Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Impact of a Pharmacist-Led Warfarin to Direct Oral Anticoagulant Conversion Initiative during the COVID-19 Pandemic

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Furthermore, the switch from VKAs to DOACs should be considered in the absence of contraindication because social distancing and stay-at-home orders were implemented. The patients on VKAs were facing unique challenges, who requiring close and continued monitoring by clinic staff to optimize the benefit–risk ratio of warfarin therapy ( Kish and Lekic, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

The Use of Oral Anticoagulation Is Not Associated With a Reduced Risk of Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis of Cohort Studies

Dai

Guo

et al. 2022

Front. Pharmacol.

View full text Add to dashboard Cite

Background: Hypercoagulability and thromboembolic events are associated with poor prognosis in coronavirus disease 2019 (COVID-19) patients. Whether chronic oral anticoagulation (OAC) improve the prognosis is yet controversial. The present study aimed to investigate the association between the chronic OAC and clinical outcomes in COVID-19 patients.Methods: PubMed, Embase, Web of Science, and the Cochrane Library were comprehensively searched to identify studies that evaluated OAC for COVID-19 until 24 July 2021. Random-effects model meta-analyses were performed to pool the relative risk (RR) and 95% confidence interval (CI) of all-cause mortality and intensive care unit (ICU) admission as primary and secondary outcomes, respectively. According to the type of oral anticoagulants [direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs)], subgroup and interaction analyses were performed to compare DOACs and VKAs. Meta-regression was performed to explore the potential confounders on all-cause mortality.Results: A total of 12 studies involving 30,646 patients met the inclusion criteria. The results confirmed that chronic OAC did not reduce the risk of all-cause mortality (RR: 0.92; 95% CI 0.82–1.03; p = 0.165) or ICU admission (RR: 0.65; 95% CI 0.40–1.04; p = 0.073) in patients with COVID-19 compared to those without OAC. The chronic use of DOACs did not reduce the risk of all-cause mortality compared to VKAs (Pinteraction = 0.497) in subgroup and interaction analyses. The meta-regression failed to detect any potential confounding on all-cause mortality.Conclusion: COVID-19 patients with chronic OAC were not associated with a lower risk of all-cause mortality and ICU admission compared to those without OAC, and the results were consistent across DOACs and VKA subgroups.Systematic Review Registration:clinicaltrials.gov, identifier CRD42021269764.

show abstract

“…Several studies have demonstrated a positive effect of pharmacist‐led anticoagulation stewardship in improving appropriate DOAC prescribing 12–14 . A recent article by Kish and colleagues described a warfarin to DOAC conversion initiative during the coronavirus disease 2019 (COVID‐19) pandemic in pharmacist‐led anticoagulation clinics utilizing a “DOAC conversion checklist.” 15 However, data describing the impact of pharmacist‐driven anticoagulation (AC) stewardship in the inpatient setting is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Inpatient pharmacy‐driven antithrombosis stewardship efforts on warfarin to direct oral anticoagulant conversions

White

Bos

Nawarskas

et al. 2023

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Background Over 6 million people in the United States require anticoagulation. Current guidelines recommend direct oral anticoagulants (DOACs) over warfarin for select indications due to increased safety and similar efficacy. However, data suggest warfarin to DOAC conversion occurs in less than 5% of patients. Objectives To assess rates of conversion from warfarin to DOACs and the rate of inpatient pharmacist assessment for warfarin to DOAC conversions using an evidence‐based DOAC checklist. Methods In this retrospective cohort study, all patients ≥18 years old admitted on warfarin from January 1, 2018 to February 28, 2020 were identified via query of the electronic health record (EHR). Patients were excluded if discharged to hospice or if anticoagulation was permanently discontinued. In January 2019, an evidence‐based checklist was developed by the inpatient antithrombosis stewardship team and embedded into an EHR‐based standardized clinical documentation form prompting pharmacist assessment for DOAC therapy. Autoregressive integrated moving average (ARIMA) models were utilized to compare pre‐ and post‐implementation rates of pharmacist‐driven evaluation for warfarin to DOAC switch along with actual conversion rates. Additional outcomes were documented reasons for not switching and proportion of newly‐switched patients referred to our antithrombosis clinic. Results Ultimately, 538 inpatient encounters were included (237 pre‐implementation of the DOAC eligibility checklist; 301 post‐implementation). Warfarin to DOAC conversions increased from a mean of 1.08 patients/month pre‐implementation of the DOAC eligibility checklist to 3.62 patients/month post‐implementation (p < 0.0001). Likewise, pharmacist evaluation for switch increased significantly from a mean of 2.00 patients/month pre‐implementation of the DOAC eligibility checklist to 17.69 patients/month post‐implementation (p < 0.0001). In addition, referrals to the anticoagulation clinic significantly increased from a mean of 1.08–4.08 patients/month (p < 0.0001). Conclusion Use of an evidence‐based checklist embedded into the inpatient EHR increased warfarin to DOAC conversions and supported overall antithrombosis stewardship efforts. Conversion rates remained fairly low. Further opportunity exists to optimize patient safety and health systems savings with ongoing stewardship efforts.

show abstract

Implementation of warfarin to direct oral anticoagulant conversion initiative in pharmacist‐run anticoagulation clinics during COVID‐19 pandemic

Cited by 6 publications

References 9 publications

Impact of a Pharmacist-Led Warfarin to Direct Oral Anticoagulant Conversion Initiative during the COVID-19 Pandemic

Impact of a Pharmacist-Led Warfarin to Direct Oral Anticoagulant Conversion Initiative during the COVID-19 Pandemic

The Use of Oral Anticoagulation Is Not Associated With a Reduced Risk of Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis of Cohort Studies

Inpatient pharmacy‐driven antithrombosis stewardship efforts on warfarin to direct oral anticoagulant conversions

Contact Info

Product

Resources

About