SHM Converge Scientific Abstract ePoster Gallery-Warfarin to Direct Oral Anticoagulants (Doacs) Transition in Eligible Patients

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This quality improvement initiative evaluated whether hospitalized patients taking warfarin could be safely transitioned to direct oral anticoagulants (DOACs) at a quaternary academic medical center. DOACs are approved for common indications such as non-valvular atrial fibrillation and venous thromboembolism, and they offer practical advantages over warfarin, including fixed dosing and fewer monitoring requirements.  <br /><br />The team screened 344 warfarin-treated patients between 2021 and 2023 who appeared to have long-term indications and no obvious contraindication to a DOAC. Pharmacy staff performed the initial eligibility review, and internal medicine residents contacted primary providers to discuss possible transitions. When patients were not transitioned, barriers were recorded.  <br /><br />Nearly half of the cohort (49.7%) had standard DOAC indications, with unspecified atrial fibrillation being the most common (27.6%). The most frequent reasons preventing transition were non-standard indications (68.27%), followed by insurance or cost issues (8.49%), kidney disease (8.49%), prior DOAC adverse effects or treatment failure (7.01%), and provider preference (3.69%). Overall, 8.2% of eligible patients were successfully switched from warfarin to a DOAC.  <br /><br />A separate baseline analysis of 17,731 patients discharged from 2017 to 2023 showed similar 30-day outcomes for warfarin and DOACs, including all-cause readmission, thrombosis-related readmission, and bleeding-related readmission.  <br /><br />The authors concluded that many appropriate patients had likely already been transitioned at their center, but opportunities remain in selected groups, such as patients with misdiagnosed valvular atrial fibrillation. Cost was an important barrier, suggesting a role for payer collaboration and patient assistance programs.

Asset Subtitle

Jack Jnani

Meta Tag

Author List Humail Patel, Jack Jnani, Ji-Cheng (Jason) Hsieh, Joseph You, Krislyn Schweiger, Lori Ohanesian, Mark Goldin, Michelle S. Glater, Nida Khan, Saumya Sharma

Category Innovations

Concept Warfarin

Concept Direct Oral Anticoagulant

Concept Quality Improvement

Concept Atrial Fibrillation

Concept Venous Thromboembolism

Distinguished Non-Finalist

Presenter Organization North Shore University Hospital

Presenting Author Jack Jnani

Track Quality Improvement

Keywords

warfarin

direct oral anticoagulants

DOAC transition

hospitalized patients

atrial fibrillation

venous thromboembolism

quality improvement

pharmacy review

insurance cost barriers

readmission outcomes

Warfarin

Direct Oral Anticoagulant

Quality Improvement

Atrial Fibrillation

Venous Thromboembolism