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| Continued Assessment of a Direct Oral Anticoagulant (DOAC) Dashboard |
| Nghi Ha, Nhan Hoang, Liza Renner, Erin Mouland, Michael Lanham, Geoff Barnes Michigan Medicine, Ann Arbor, MI, United States |
Introduction As oral anticoagulation shifts from warfarin to direct oral anticoagulants (DOACs), a new management model is required to ensure safe, effective therapy. Michigan Medicine implemented a DOAC Dashboard within the electronic health record (EHR) to track patients needing DOAC dose or therapy adjustments based on renal function, age, weight, indication, and drug-drug interactions. The Dashboard currently manages 15,326 patients. This study aims to describe the use of the DOAC Dashboard and evaluate the effectiveness of pharmacist-led management in real-time. Methods A retrospective descriptive study was conducted on DOAC Dashboard alerts from January 4, 2022, to January 26, 2024. Results A total of 4443 alerts were identified (3228 noting missing clinical data and 1215 noting know dosing issues). All missing clinical alerts were resolved by updating missing data. Of the 1215 known dosing issues alerts, 487 (40.1%) required intervention. Patients requiring intervention were older and had higher serum creatinine and lower body weight. Overall, most interventions were performed among patients with AFib. Among the 487 interventions, 363 (74.5%) were accepted by providers and patients. High-dose alerts resulted in 248 (69.5%) interventions (87.9% acceptance) and low-dose alerts resulted in 225 (58.6%) interventions (59.6% acceptance). There was no difference in interventions between patients on apixaban vs. rivaroxaban. Approximately 15% of patients have repeated alerts over time, with an average of 3.3 repeated alerts per patient. Conclusion The DOAC Dashboard is an efficient and targeted approach to manage patients on DOAC in real-time. Majority (74.5%) of pharmacist interventions were implemented. |