Navigating warfarin management: Insights from the Hamad Medical Corporation during and after COVID-19

Objective: The objective of this study was to assess the effects of COVID-19 safety measures on outcomes in patients receiving warfarin for cardiac indications at the Heart Hospital’s anticoagulation clinic, Hamad Medical Corporation. Methods: Two cohort surveys were studied: pre-COVID-19 (December 1, 2018, to February 28, 2019) and post-COVID-19 (April 1, 2020, to June 20, 2020). Collected data included demographics, chronic conditions, warfarin indications, clinic visits, and safety and efficacy outcomes. Thrombotic events and bleeding events were tracked in order to assess the safety of the anticoagulant clinic’s adopted procedures during the COVID-19 pandemic. Results: Patients who visited the clinic for 3 months before the pandemic were included in the pre-COVID-19 group, while those who visited at the peak of the pandemic in 2020 were included in the post-COVID-19 group. During the pandemic, significant reductions in thrombotic and bleeding events were noted, with a noteworthy increase in time in the therapeutic range. Notable findings included decreased ischemic strokes (13 to 1 case, p -value = 0.022) and reduced major bleeding (9 to 4 cases, p -value < 0.001). Time in the therapeutic range improved from 60% ± 20% to 64% ± 20% ( p -value < 0.001). Clinic visits decreased during the pandemic but significantly increased afterward. Conclusion: COVID-19 safety measures at the anticoagulation clinic were safe and highly effective in optimizing therapy. Larger studies across multiple centers are recommended to further assess the broader safety and efficacy. The study emphasizes the ongoing need for improvements in anticoagulation management during and beyond the pandemic, potentially reshaping future care.