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Leveraging Evidence-Based Practices for Ambulatory VTE Patients to be Safe with Direct Oral Anticoagulants: LEAVE SAFE with DOACs

MHCI Investigators: Alok Kapoor, David McManus, Abir Kanaan, Kathleen Mazor, Jerry Gurwitz
Funding Agency: Agency for Healthcare Research and Quality (AHRQ) 
Status: Ongoing

Project Overview: Patients with new episodes of venous thromboembolism (VTE) are at an elevated risk for adverse drug events (ADEs). The ambulatory VTE population includes most patients with deep vein thrombosis (DVT) and many patients with pulmonary embolism. Unlike patients with atrial fibrillation, who typically receive follow-up with a cardiologist, or patients attending warfarin clinics, ambulatory VTE patients prescribed DOACs do not have established pathways for follow-up. They also do not typically have consultation by a clinical pharmacist as a hospitalized patient often does. Recently the Anticoagulation Forum, a multidisciplinary nonprofit organization focused on anticoagulation issues, published the DOAC Checklist for Optimal Care Transitions (DOAC Checklist) to elaborate the steps required to ensure a safe transition of care in patients prescribed DOACs for treatment of VTE. We propose operationalizing the items of the DOAC Checklist to create a comprehensive intervention delivered by clinical pharmacists with the goal of preventing DOAC-related clinically important medication errors which includes preventable ADEs, ameliorable ADEs (ADEs in which the severity or duration could have been reduced), and potential ADEs (medication errors with the potential to cause harm. Given the growth of the ambulatory VTE population prescribed DOACs, the associated risks with this class of medications, and the lack of defined pathways for these patients, our care transition intervention has the potential for enormous impact in preventing clinically important medication errors and improving the quality of care transition, patient knowledge, and medication adherence.

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