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How a 'Novel' approach can make your anticoagulation clinic more important than ever

February 22, 2017

    Novel Oral Anticoagulants (NOACs) have been receiving increasing attention as alternatives to warfarin in mitigating stroke risk for atrial fibrillation (AF) patients. These drugs may pose a threat to the over 3,000 anticoagulation clinics across the country that base their business on the maintenance and management of warfarin treatments.

    But NOACs are far from an excuse to close up shop—instead, their rise can be seen as an opportunity for anticoagulation clinics to cement their foundational role as a center for care management.

    Warfarin has been in use since the 1950s (President Dwight Eisenhower was an early recipient of the drug after experiencing a heart attack in 1955) and achieved a near-total monopoly on the treatment of blood clots and prevention of deep vein thrombosis, pulmonary embolism, and stroke.

    While highly effective, warfarin also requires intensive and ongoing care, as metabolism, diet, and interaction with other drugs can shift blood balance and put the patient at risk of clots and embolisms. In order to meet these evolving care demands, many hospitals established anticoagulation clinics to optimize patients' medication management.

    NOACs arrive in 2009

    In contrast, NOACs, which were first introduced in 2009, require far less follow-up care, making them more convenient for both patients and providers. NOACs tend to have fewer side effects compared with warfarin, but early adoption of the drugs has been slow. Many providers are still unfamiliar with them, and patients tend to prefer warfarin out of habit. The FDA also recently placed NOACs on the latest watch list of drugs with potential safety issues due to reports of vasculitis.

    With the evolving questions over appropriate medication therapy, it is unlikely that the need for anticoagulation clinics will diminish entirely in the short-term. But as understanding of the drugs improves, the grip anticoagulation clinics have held on treatment may begin to slip.

    How anticoagulation clinics must respond

    To respond to these changes, anticoagulation clinics must adapt to strengthen their role as a driver of patient engagement and compliance.

    Regardless of whether a patient uses warfarin or NOACs, compliance will remain pivotal to the success or failure of anticoagulation therapy. Anticoagulation clinics can serve as centers of education in order to maintain high levels of patient adherence and safety. In fact, according to a Veterans Affairs study, anticoagulation clinics' dedication to monitoring NOAC medications was associated with higher likelihoods of patient adherence. To increase accessibility to patients in the future, anticoagulation clinics may look to explore telehealth and virtual care delivery options.

    In order to become a center of patient education, engagement, and safety, providers will need to keep up to date with the full breadth and depth of treatment options. Increasingly, providers will be expected to select from a variety of anticoagulation therapies to best suit the needs of each patient. But regardless of which medication a patient uses, checkups and ongoing care maintenance remain paramount. Even patients using NOACs are recommended to visit a clinic at least once every three to six months. Nurses and pharmacists staffing anticoagulation clinics must be well-versed in how to manage these patients' care needs.

    Finally, anticoagulation clinics can leverage their expertise to help mitigate peri-procedural risk. Each year, atrial fibrillation procedures require over 500,000 patients to interrupt their anticoagulation therapy. The experience of clinic providers can prove integral to minimizing complications during the treatment transition. Clinics can also position themselves as a centralized resource for patients, providing patients with care coordination, and alleviating the burden from primary care physicians, cardiologists, and surgeons.

    Providers and patients alike stand to gain substantially from reducing readmissions and adverse drug episodes. As a center of care education, management, and coordination, anticoagulation clinics are in a position to become more indispensable, not less, as the care landscape changes. 

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