Findings from a US-based health system demonstrated a continued need for increased oversight of long-term use of direct-acting oral anticoagulants (DOACs) to promote adherence to policies and procedures established at the organization.

The study was presented by Jonathon Burdick, PharmD, BCPS, of the University of Wisconsin Hospital and Clinics (UW Health) in Madison, Wisconsin, at the Thrombosis & Hemostasis Summit of North America (THSNA) 2020 Virtual Conference

“Long-term monitoring plans for DOACs are often unaccounted for due to variability amongst institutions and a lack of clear direction from national organizations,” wrote the authors. “Recently, the Joint Commission has mandated that healthcare organizations develop written policies and procedures to help standardize anticoagulation management.”

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Within the UW Health system, the anticoagulation clinic manages DOAC therapy on a consultative basis. Their protocol outlines how to prescribe DOACs and includes a long-term monitoring plan consisting of periodic telephone check-ins with patients and laboratory monitoring (hemoglobin, platelet count, creatinine, and alanine transaminase).     

This study evaluated UW Health’s current practices for DOAC management and compared those to the protocol used by the anticoagulation clinic to identify areas for improvement. 

Dr Burdick and colleagues conducted a retrospective review of DOAC monitoring practices on randomly selected patients who received new DOAC prescriptions at UW Health from June to August 2018 and had at least 1 year of follow up.  

In total, 1643 patients were prescribed a DOAC; however, most of these patients were not on long-term follow-up. In the final analysis, 120 patients taking DOACs and were on long-term follow-up were included in the study.

The investigators found that 12 patients (10%) were prescribed an unapproved DOAC dose according to the indication for use. Only 57% of patients had baseline laboratory results, and only 31% of patients had complete follow-up laboratory monitoring.

Thus, the team revised their protocol to decrease the number of laboratory draws for first year of therapy (from 4 to 3) and decreased the number of patient assessment calls (from 5 to 3).  In addition to streamlining DOAC monitoring, the team estimated that these changes would result in a cost savings of more than $13,000 per year in laboratory costs and an annual time savings of 52 hours for anticoagulation clinic staff.

“We’re decreasing the number of patient assessments that we have our pharmacy staff take part in, freeing up some time for when we [implement this protocol] in a bigger population,” said Dr Burdick in an interview. “Because DOACs are definitely not going away. We’re only going to see their numbers increase.”

After implementation of the new protocol, the investigators plan to conduct further analyses to determine the impact of pharmacy staff on error reporting and DOAC oversight.


Burdick J, Patterson C, Rose A. Standardization of direct oral anticoagulant management across a health system. Abstract presented at: THSNA 2020 Thrombosis & Hemostasis Summit of North America; October 27-30, 2020. Abstract 94.