Implementation of a Pharmacist-Led Direct Oral Anticoagulant Management Service within a Community Hospital
Faculty Mentor
Rebecca Cope
Major/Area of Research
Pharm.D., Pharmacy
Description
INTRODUCTION: Direct oral anticoagulants (DOACs) have replaced warfarin for stroke prevention in atrial fibrillation (AF) and treatment of venous thromboembolism (VTE) due to fewer side effects and monitoring requirements. While pharmacist-led warfarin management is well established, data on pharmacist involvement in DOAC management remain limited. This study describes the newly established pharmacist-led DOAC Management Service at The Brooklyn Hospital Center (TBHC) and evaluates clinical impact.
METHOD: This retrospective chart review included adult patients prescribed DOACs and enrolled in TBHC’s outpatient anticoagulation service from September 1st, 2024, to September 1st, 2025. Patients on non-DOAC anticoagulants were excluded from the study. Monthly reports identified potential patients, followed by an initial chart review and provider outreach for referral. Data collected included patient demographics, visit details, and pharmacist interventions documented in the electronic medical record. The primary endpoint was the total number of pharmacist interventions. Secondary endpoints included interventions by type, chart reviews per patient, encounters per patient, interventions per encounter, and interventions per patient. Descriptive statistics were utilized to report demographic data.
RESULTS: A total of 108 patients were referred to the DOAC anticoagulation service during the study period. Clinical pharmacists documented 146 interventions for the total study population, with adherence counseling (26.0%), laboratory monitoring (17.8%), and DOAC refills (14.4%) being the most common. Among the 62 patients who presented for at least one visit during the study period, clinical pharmacists conducted an average of 2.02 chart reviews and 1.63 encounters per patient, resulting in 101 total visits, a mean of 1.39 interventions per visit, and 2.26 interventions per patient.
DISCUSSION/CONCLUSION: The pharmacist-led DOAC Management Service at TBHC generated meaningful clinical interventions that improved patient care and safety. These findings underscore the value of pharmacist involvement and the expansion of DOAC management services in outpatient populations.
Implementation of a Pharmacist-Led Direct Oral Anticoagulant Management Service within a Community Hospital
INTRODUCTION: Direct oral anticoagulants (DOACs) have replaced warfarin for stroke prevention in atrial fibrillation (AF) and treatment of venous thromboembolism (VTE) due to fewer side effects and monitoring requirements. While pharmacist-led warfarin management is well established, data on pharmacist involvement in DOAC management remain limited. This study describes the newly established pharmacist-led DOAC Management Service at The Brooklyn Hospital Center (TBHC) and evaluates clinical impact.
METHOD: This retrospective chart review included adult patients prescribed DOACs and enrolled in TBHC’s outpatient anticoagulation service from September 1st, 2024, to September 1st, 2025. Patients on non-DOAC anticoagulants were excluded from the study. Monthly reports identified potential patients, followed by an initial chart review and provider outreach for referral. Data collected included patient demographics, visit details, and pharmacist interventions documented in the electronic medical record. The primary endpoint was the total number of pharmacist interventions. Secondary endpoints included interventions by type, chart reviews per patient, encounters per patient, interventions per encounter, and interventions per patient. Descriptive statistics were utilized to report demographic data.
RESULTS: A total of 108 patients were referred to the DOAC anticoagulation service during the study period. Clinical pharmacists documented 146 interventions for the total study population, with adherence counseling (26.0%), laboratory monitoring (17.8%), and DOAC refills (14.4%) being the most common. Among the 62 patients who presented for at least one visit during the study period, clinical pharmacists conducted an average of 2.02 chart reviews and 1.63 encounters per patient, resulting in 101 total visits, a mean of 1.39 interventions per visit, and 2.26 interventions per patient.
DISCUSSION/CONCLUSION: The pharmacist-led DOAC Management Service at TBHC generated meaningful clinical interventions that improved patient care and safety. These findings underscore the value of pharmacist involvement and the expansion of DOAC management services in outpatient populations.