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Objective: To pilot a process for identifying and switching high-risk warfarin patients to direct oral anticoagulants (DOACs) in nonvalvular atrial fibrillation (AF) or venous thromboembolism (VTE). Methods: A pharmacy resident identified high-risk warfarin patients using three criteria. The resident reviewed medical charts, communicated recommendations to the primary care physician (PCP), and scheduled patients for appointments to switch to DOACs. Patients were followed every 1 to 3 months after initiating DOACs. The primary outcome of the study was the percentage of high-risk warfarin patients before and after process implementation. Secondary outcomes at 6 months included bleeding or thrombotic events, patient-reported side effects, recommendation acceptance rates, adherence rates, clinic time in therapeutic range (TTR), and patient satisfaction. Results: Out of 76 patients evaluated, 22.4% were identified as high-risk using the pre-specified criteria. After program implementation, this percentage was reduced to 9.2%. No significant adverse events occurred by 3-month follow-up, and 100% of recommendations were accepted by physicians. Adherence rates and clinic TTR also improved after implementation (87.5% to 94% and 60.9% to 81.1%, respectively). Overall, patients reported satisfaction with switching from warfarin to DOAC. Conclusions: A pilot process was successful in reducing the percentage of high-risk warfarin patients by switching to DOAC therapy.

A pilot process to identify and switch high-risk warfarin patients to direct oral anticoagulants