From the Department of Pharmacy Services, Brigham and Women's Hospital, Boston, MA.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
Crit Pathw Cardiol. 2021 Jun 1;20(2):103-107. doi: 10.1097/HPC.0000000000000251.
The standard of care for stroke prevention in nonvalvular atrial fibrillation (AF) is the use of direct oral anticoagulants (DOACs). However, many patients established on warfarin therapy have not been considered for a transition to a DOAC.
Assess the AF patient population of Brigham and Women's Hospital (BWH) Anticoagulation Management Service (AMS) currently being treated with warfarin, transition eligible patients to a DOAC, and identify barriers to the transitional process.
Patient characteristics were analyzed to describe the overall AF population and a systematic process was used to determine clinical candidacy for a transition from warfarin to a DOAC. After being deemed eligible by both the referring physician and the AMS pharmacist, each patient was contacted and offered the opportunity for DOAC transition. Endpoints included number of successful transitions and commonly encountered barriers.
Out of the 1407 total AF patients on warfarin managed by BWH AMS, there were 787 patients identified as candidates for DOAC transition and a successful transition was completed for 250 (31.8%) of them. Barriers to transition included patient preference for warfarin (n = 247, 31.4%), referring physician preference for warfarin (n = 112, 14.2%), cost (n = 88, 11.2%), AMS pharmacist preference for warfarin (n = 70, 8.9%), and previous DOAC intolerance (n = 20, 2.5%).
Every institution or provider network that manages AF patients on warfarin should assess their population on a regular basis to identify candidates for DOAC therapy. Our initiative outlines a process for identifying and transitioning DOAC-eligible AF patients established on warfarin therapy and describes the most commonly encountered barriers to DOAC therapy.
在非瓣膜性心房颤动（AF）中，预防中风的标准治疗方法是使用直接口服抗凝剂（DOACs）。然而，许多接受华法林治疗的患者尚未考虑转为 DOAC。
评估目前正在接受 Brigham and Women's Hospital（BWH）抗凝管理服务（AMS）治疗的华法林患者的 AF 患者人群，将符合条件的患者转为 DOAC，并确定过渡过程中的障碍。
分析患者特征以描述整体 AF 人群，并采用系统的方法确定从华法林转为 DOAC 的临床适应证。在经主治医生和 AMS 药剂师认定符合条件后，每位患者都被联系并提供转为 DOAC 的机会。终点包括成功转换的数量和常见障碍。
在 BWH AMS 管理的 1407 例 AF 患者中，有 787 例患者被认为适合转为 DOAC，其中 250 例（31.8%）成功完成了转换。过渡障碍包括患者对华法林的偏好（n = 247，31.4%）、主治医生对华法林的偏好（n = 112，14.2%）、费用（n = 88，11.2%）、AMS 药剂师对华法林的偏好（n = 70，8.9%）和先前的 DOAC 不耐受（n = 20，2.5%）。
每个管理华法林治疗 AF 患者的机构或医疗服务网络都应定期评估其患者人群，以确定 DOAC 治疗的候选者。我们的计划概述了识别和过渡 DOAC 合格的 AF 患者的过程，并描述了 DOAC 治疗最常见的障碍。
