Impact of oral direct thrombin inhibitors on anticoagulation clinics.
OBJECTIVE
To characterize the services and activities performed by anticoagulation clinics (ACCs) across the United States, examine the anticipated impact that oral direct thrombin inhibitors (DTIs) will have on the clinical services of ACCs, and elicit possible management strategies to realign services provided by ACCs and opportunities for restructuring clinical services.


METHODS
A survey was developed in consultation with content experts in the field, pretested by several ACC providers, and subsequently refined. Surveys were mailed to 400 randomly selected ACC-based providers.


RESULTS
The final usable response rate was 34.5% (115 of 333 surveys). Respondents anticipated that the number of patient visits/month would decrease from a median of 336 (interquartile range [IQR] 151-775) to 150 (IQR 71-350, p<0.001) after the introduction of oral DTIs. In addition, time spent on many direct and indirect patient care activities currently performed by ACCs was expected to decline. Respondents indicated that ACCs may find new roles by providing guidance on individual suitability for therapy, managing the transition to oral DTIs, providing education for patients and health care providers on thrombotic disease state management, monitoring patients for recurrent thrombosis and risk of bleeding complications, monitoring patient compliance, and providing counseling and safety surveillance for patients receiving treatment with oral DTIs.


CONCLUSIONS
The advent of oral DTIs is likely to have a significant impact on the structure and delivery of antithrombotic services. Clinics that are proactive and redesign their patient care services to consider emerging anticoagulant agents will be more likely to remain relevant and viable.
Nutescu
Edith A
EA
Department of Pharmacy Practice, University of Illinois at Chicago, IL 60612, USA.
Pickard
A Simon
AS
Blackburn
Juan C
JC
Wittkowsky
Ann K
AK
Ansell
Jack
J
Schumock
Glen T
GT
D000284:Administration, Oral; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006490:Hemostatics / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D006801:Humans; D011795:Surveys and Questionnaires; D013917:Thrombin / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D014481:United States
D006490:Hemostatics; D013917:Thrombin