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Efficient operation of a high-volume anticoagulation clinic
M T Foss1, P H Schoch, C D Sintek
1Department of Pharmacy, Department of Veterans Affairs Medical Center, Denver, CO 80220, USA.
Summary
Pharmacist-led anticoagulation clinics improve patient outcomes. This model reduced bleeding and thromboembolic events by optimizing warfarin management for veterans.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Health Services Research
Background:
- Anticoagulation management is complex and requires careful monitoring.
- Traditional models may not always achieve optimal therapeutic ranges.
- The Department of Veterans Affairs (VA) sought to improve anticoagulation services.
Purpose of the Study:
- To describe a pharmacist-operated anticoagulation clinic at a VA medical center.
- To evaluate the efficiency and effectiveness of this model of care.
Main Methods:
- A standardized protocol was developed for warfarin management.
- Pharmacists were granted privileges to prescribe and adjust warfarin dosages.
- A dedicated clinic utilized same-day laboratory monitoring and patient education.
- A custom computer program facilitated patient scheduling and data tracking.
Main Results:
- The clinic managed 600 patients with 1.35 full-time equivalent pharmacists.
- Approximately 67% of patients were maintained within the therapeutic International Normalized Ratio (INR) range.
- Bleeding complication rates were lower (1.1%) compared to usual care (2.0%).
- Thromboembolic complication rates were significantly lower (0.9%) versus usual care (3.1%).
Conclusions:
- A pharmacist-operated anticoagulation clinic can provide efficient and effective care.
- Key components include clinical privileging, standardized protocols, and integrated technology.
- This model demonstrates improved patient safety and reduced adverse events in anticoagulation therapy.