Department of Pharmacotherapy, University of Utah, 30 South 2000 East, Salt Lake City, UT, 84112, USA.
University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT, USA.
J Thromb Thrombolysis. 2020 Oct;50(3):739-745. doi: 10.1007/s11239-020-02064-0.
The role of dedicated anticoagulation management services (AMS) for patients receiving direct oral anticoagulant (DOAC) therapy is unclear. The objective of our study was to describe DOAC management in patients who were and were not managed by an AMS. We conducted a retrospective cohort study among patients with atrial fibrillation at the University of Utah Health (UUH) who received DOAC therapy between January 2013 and June 2016. Patients in the AMS group were managed by a pharmacist-led AMS whereas those in the non-AMS group were managed by other providers. The number and type of provider encounters and interventions related to DOAC therapy and a composite endpoint of thromboembolism, bleeding, and all-cause mortality were recorded. Overall, 90 and 370 patients were managed in the AMS and non-AMS groups, respectively. AMS group patients had greater chronic disease burden as measured by the Charlson comorbidity index. AMS group patients had more frequent DOAC-related encounters than non-AMS group patients but both groups had similar DOAC therapy intervention rates. Over half of patients in the AMS group received potentially duplicative interventions from their regular clinicians. The composite endpoint occurred in 18.9% and 13.5% of AMS and non-AMS group patients, respectively (p = 0.29). Patients managed by AMS providers were more complex and had more frequent encounters regarding their DOAC therapy than those managed by non-AMS providers. However, there was evidence of duplicative DOAC therapy management efforts. No difference between AMS and non-AMS groups in the composite clinical endpoint was detected.
专门抗凝管理服务（AMS）在接受直接口服抗凝剂（DOAC）治疗的患者中的作用尚不清楚。我们的研究目的是描述接受和未接受 AMS 管理的患者的 DOAC 管理情况。我们对 2013 年 1 月至 2016 年 6 月在犹他大学健康中心（UUH）接受 DOAC 治疗的房颤患者进行了回顾性队列研究。AMS 组的患者由药剂师领导的 AMS 管理，而非 AMS 组的患者由其他提供者管理。记录了与 DOAC 治疗相关的提供者就诊次数和类型以及干预措施，以及血栓栓塞、出血和全因死亡率的复合终点。总的来说，分别有 90 名和 370 名患者在 AMS 和非 AMS 组中接受了治疗。AMS 组患者的慢性疾病负担更重，这一指标是由 Charlson 合并症指数来衡量的。与非 AMS 组患者相比，AMS 组患者的 DOAC 相关就诊次数更多，但两组的 DOAC 治疗干预率相似。AMS 组的一半以上患者从他们的常规临床医生那里接受了可能重复的干预措施。复合终点在 AMS 组和非 AMS 组患者中的发生率分别为 18.9%和 13.5%（p=0.29）。与非 AMS 组患者相比，由 AMS 提供者管理的患者在 DOAC 治疗方面更复杂，就诊次数更频繁。然而，存在重复的 DOAC 治疗管理工作的证据。在复合临床终点方面，AMS 组和非 AMS 组之间没有差异。
