Implementation and Preliminary Clinical Outcomes of a Pharmacist-managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge

Baely M. Direnzo, Daren Beam, Jeffrey Kline, Karishma S. Deodhar, Zachary A. Weber, Christie M. Davis, Todd A. Walroth

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Abstract

Objective: The objective was to describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using a non-vitamin K oral anticoagulant versus care by a primary care provider (PCP). Methods: Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with a non-vitamin K oral anticoagulant and follow-up either in a pharmacist-managed VTE clinic or with their PCP. Pharmacists in the VTE clinic work independently under a collaborative practice agreement (CPA). An evaluation of 34 patients, 17 in each treatment arm, was conducted to compare the differences in treatment-related outcomes of rivaroxaban when managed by a pharmacist versus a PCP. Results: The primary endpoint was a 6-month composite of anticoagulation treatment-related complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p = 1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in eight patients in the pharmacist group versus no patients in the control group. No differences were seen among other secondary endpoints. Conclusions: The pharmacist-managed clinic is a novel expansion of clinical pharmacy services that treats patients with low-risk VTEs with rivaroxaban in the outpatient setting. The evaluation of outcomes provides support that pharmacist-managed care utilizing standardized protocols under a CPA may be as safe as care by a PCP.

Original languageEnglish (US)
JournalAcademic Emergency Medicine
DOIs
StateAccepted/In press - Jan 1 2017

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Venous Thromboembolism
Pharmacists
Hospital Emergency Service
Primary Health Care
Medication Adherence
Thromboembolism
Anticoagulants
Hospital Pharmacy Services
Hemorrhage
Workflow
Managed Care Programs
Therapeutics
Ambulatory Care Facilities
Rivaroxaban
Hospitalization
Outpatients
Control Groups
Health

ASJC Scopus subject areas

  • Emergency Medicine

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Implementation and Preliminary Clinical Outcomes of a Pharmacist-managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge. / Direnzo, Baely M.; Beam, Daren; Kline, Jeffrey; Deodhar, Karishma S.; Weber, Zachary A.; Davis, Christie M.; Walroth, Todd A.

In: Academic Emergency Medicine, 01.01.2017.

Research output: Contribution to journalArticle

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