Three‐year clinical interventions from an outpatient multidisciplinary direct oral anticoagulant monitoring service

Introduction Direct oral anticoagulants (DOAC) are increasingly utilized for the prevention of thrombotic events. Unlike warfarin they do not require drug‐level monitoring making dedicated DOAC monitoring uncommon. The purpose of this study is to describe the interventions made by a DOAC monitoring service over 3 years. Materials and Methods This was a single‐center prospective observational study of patients seen at an outpatient clinic between February 14, 2017 and February 13, 2020. Following referral patients met a pharmacist for a DOAC‐specific visit. Patient demographics and clinical interventions were collected for all patients. Continuous quality improvement status was received from the local Institutional Review Board. Results A total of 153 patients completing 336 visits were included. The median age was 75 years (interquartile range [IQR] 69‐81) and 41.2% were male. Apixaban was the most common DOAC (82.4% of visits) and atrial fibrillation (AF) was the most common indication (69.7% of visits). A total of 299 interventions were made over 336 visits with an average of 0.9 interventions per visit; the first visit had an average of 1.1 interventions per visit made. Need for updated laboratory monitoring (101 visits, 30.1% of visits) was the most common intervention. There were 94 interventions related to nonadherence and 24 interventions for incorrect dosing due to renal function, drug‐drug interaction, or indication. Conclusions A DOAC monitoring service frequently made interventions. Routine DOAC monitoring should be considered for all patients. It remains unclear if routine DOAC monitoring reduces the rate of clinical outcomes.