{"doi":"10.1002/rth2.12735","title":"Are outpatient anticoagulation management services the wave of the future (again)?","abstract":"When the first direct oral anticoagulants (DOACs) were Food and Drug Administration‐approved and made available for clinical use in the treatment of venous thromboembolism (VTE) and stroke prevention of atrial fibrillation, the excitement over options that required neither routine monitoring nor frequent dose adjustments was felt by prescribers and patients alike. Although much has been learned about DOACs since then, the enthusiasm for these features has not dimmed. Apixaban, the most widely used DOAC, was ranked the 52nd most commonly prescribed drug in 2019 according to www.clincalc.com. More than 14 million prescriptions were filled for more than 3 million patients during that year. DOACs continue to be celebrated for greater convenience and, in some cases, greater safety over vitamin K antagonists (VKAs). In their recent paper, Sylvester et al.1.Sylvester K.W. Chen A. Lewin A. Fanikos J. Goldhaber S.Z. Connors J.M. Optimization of DOAC management services in a centralized anticoagulation clinic.Res Pract Thromb Haemost. 2022; 610.1002/rth2.12696Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar report on their successful experience managing DOACs using an outpatient anticoagulation management service (AMS). The original model for the outpatient AMS was designed to facilitate the frequent monitoring and nuanced dose adjustments necessary to optimize effectiveness and minimize bleeding in patients using VKAs.2.Mohammad I. Korkis B. Garwood C.L. Incorporating comprehensive management of direct oral anticoagulants into anticoagulation clinics.Pharmacotherapy. 2017; 37: 1284-129710.1002/phar.1991Crossref PubMed Scopus (22) Google Scholar Such services were demonstrated to be cost effective, simultaneously adding quality adjusted life years and reducing cost of care due, at least in part, to a reduction in strokes (ischemic or hemorrhagic) and other embolic events.3.Sullivan P.W. Arant T.W. Ellis S.L. Ulrich H. The cost effectiveness of anticoagulation management services for patients with atrial fibrillation and at high risk of stroke in the US.Pharmacoeconomics. 2006; 24: 1021-103310.2165/00019053‐200624100‐00009Crossref PubMed Scopus (119) Google Scholar, 4.Chua W.B. Cheen H.H. Kong M.C. Chen L.L. Wee H.L. Modelling the cost‐effectiveness of pharmacist‐managed anticoagulation service for older adults with atrial fibrillation in Singapore.Int J Clin Pharm. 2016; 38: 1230-124010.1007/s11096‐016‐0357‐7Crossref PubMed Scopus (6) Google Scholar Many of these benefits were presumed to be directly linked to increased time in therapeutic range, a metric not monitored in the use of DOACs because of generally reliable pharmacokinetics. However, even in the absence of a need for frequent dose adjustments DOACs remain high‐risk medications and are vulnerable to dosing errors, medication interactions and variability from renal and hepatic function as well as absorption. According to Sylvester et al,1.Sylvester K.W. Chen A. Lewin A. Fanikos J. Goldhaber S.Z. Connors J.M. Optimization of DOAC management services in a centralized anticoagulation clinic.Res Pract Thromb Haemost. 2022; 610.1002/rth2.12696Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar rationale for using AMS for DOAC patients include safer and more effective transitions of care and reduced provider burnout. Specific services provided for DOAC patients include dose adjustments, procedure planning, assessment of adherence, assessment for bleeding/recurrent thromboembolism, side effects, new medications/interactions, and periodic laboratory assessment for changes in renal or liver function. Such services not only improve patient care but can serve to reduce burden on an already overburdened health care system, particularly in the wake of the SARS‐CoV‐2 pandemic. Over a 4‐year period, the pharmacist‐run Brigham and Women's Hospital AMS saw 1622 patients in 3154 follow‐up visits, which may otherwise have occurred in busy primary care and cardiology","journal":"Research and Practice in Thrombosis and Haemostasis","year":2022,"id":290072,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9498,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":479428,"name":"Bethany Samuelson Bannow","orcid":"0000-0002-9981-8990","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T00:30:26.667578Z","pmid":"35664531","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}