Clinical and safety impact of an inpatient Pharmacist‐Directed anticoagulation service

500 patients receiving warfarin on two medical and two cardiology units at a large, urban teaching hospital and level 1 trauma center.

Inpatient Pharmacist-Directed Anticoagulation Service (PDAS) providing dosing, monitoring, and coordination of transition from the inpatient-to-outpatient setting.

Standard care (implied by cluster randomized design without specific active comparator described)

Transition of care compliance (appropriate enrollment in anticoagulation clinic, documented inpatient-to-outpatient provider contact, documented inpatient provider-to-anticoagulation clinic communication, and patient follow-up within 5 days of discharge) and composite safety endpoint (thromboembolism, major bleeding, or INR ≥5) assessed during hospitalization and 30 days after discharge.composite