Poster presentation completed at ASHP Midyear Clinical Conference & Exhibition.

Background: Direct oral anticoagulants (DOACs) are the preferred treatment for patients with venous thromboembolism and atrial fibrillation and are an attractive alternative to vitamin K antagonists in multiple indications for long-term anticoagulation. Although DOACs require less frequent clinical monitoring than vitamin K antagonists and their standardized dosing is often more convenient for patients, these medications still require monitoring. Medication adherence, monitoring renal function, hepatic function and drug interactions are important safety concerns for managing patients on DOAC therapy. Previous studies have shown pharmacist can impact monitoring, dosing and adherence to DOACs. This study aims to evaluate the impact of pharmacist-led anticoagulation services on appropriate dosing and monitoring of DOAC agents compared to other providers in the healthcare system. At Parkview Health’s Anticoagulation Therapy Unit, patients on DOACs have an initial visit where dosing, renal function, liver function and drug interactions are monitored. Patients are also counseled on adherence, adverse drug reactions and signs or symptoms of adverse events like stroke, VTE or bleeds. Follow up visits take place at 4 weeks, 3 months, 6 months, then every 6-12 months based on patient specific factors. At these visits patients are assessed using a DOAC checklist.

Primary Endpoint: Adherence to recommended frequencies for blood work and dosing

Secondary Endpoint: Incidence of venous thromboembolism, cerebrovascular accident, or clinically relevant bleeding, rate of use of interacting or contraindicated medications at any point of DOAC therapy.

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