Anticoagulation Clinic in the VA Pittsburgh Healthcare System

This article describes the Anticoagulation Clinic (ACC) within the Veterans Administration Healthcare System. The clinic has been in operation for 10 years and has increased patient visits by 550 percent over this time period. Unlike many ACCs, inpatient anticoagulation management services have lagged behind outpatient services. The typical patient is an older white male who is prescribed warfarin for a cardiac condition (atrial fibrillation, mechanical heart valve replacement, congestive heart failure/cardiomyopathy). The VA system provides prescriptive authority and offers much latitude for patient management by ACC pharmacists. A comprehensive credentialing process has been developed, and quality improvement monitors show warfarin-related complications are comparable to other clinics and are less than routine medical care. In general, patients are satisfied with the care they receive and are comfortable with pharmacists monitoring and adjusting their warfarin therapy.