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Anticoagulation Control, Patient Outcomes, and Health Care Costs

Elaine Chiquette, PharmD; Mary G. Amato, PharmD, MPH; Henry I. Bussey, PharmD

Arch Intern Med. 1998;158:1641-1647.

Background  The outcomes of an inception cohort of patients seen at an anticoagulation clinic (AC) were published previously. The temporary closure of this clinic allowed the evaluation of 2 more inception cohorts: usual medical care and an AC.

Objective  To compare newly anticoagulated patients who were treated with usual medical care with those treated at an AC for patient characteristics, anticoagulation control, bleeding and thromboembolic events, and differences in costs for hospitalizations and emergency department visits.

Results  Rates are expressed as percentage per patient-year. Patients treated at an AC who received lower-range anticoagulation had fewer international normalized ratios greater than 5.0 (7.0% vs 14.7%), spent more time in range (40.0% vs 37.0%), and spent less time at an international normalized ratio greater than 5 (3.5% vs 9.8%). Patients treated at an AC who received higher-range anticoagulation had more international normalized ratios within range (50.4% vs 35.0%), had fewer international normalized ratios less than 2.0 (13.0% vs 23.8%), and spent more time within range (64.0% vs 51.0%). The AC group had lower rates (expressed as percentage per patient-year) of significant bleeding (8.1% vs 35.0%), major to fatal bleeding (1.6% vs 3.9%), and thromboembolic events (3.3% vs 11.8%); the AC group also demonstrated a trend toward a lower mortality rate (0% vs 2.9%; P=.09). Significantly lower annual rates of warfarin sodium–related hospitalizations (5% vs 19%) and emergency department visits (6% vs 22%) reduced annual health care costs by $132086 per 100 patients. Additionally, a lower rate of warfarin-unrelated emergency department visits (46.8% vs 168.0%) produced an additional annual savings in health care costs of $29972 per 100 patients.

Conclusions  A clinical pharmacist–run AC improved anticoagulation control, reduced bleeding and thromboembolic event rates, and saved $162058 per 100 patients annually in reduced hospitalizations and emergency department visits.

From the Clinical Pharmacy Programs at The University of Texas at Austin and The University of Texas Health Sciences Center at San Antonio (Drs Chiquette, Amato, and Bussey); Anticoagulation Clinic, University Health Center Downtown, San Antonio (Dr Amato); Pharmacotherapy Consultants Clinic, University Health Center Downtown, and Anticoagulation Clinics of North America, San Antonio (Dr Bussey). Dr Chiquette is now with the San Antonio Cochrane Center, Audie Murphy Memorial Veterans Affairs Hospital, San Antonio. Dr Amato is now with the Frank M. Tejeda Veteran Affairs Outpatient Clinic, San Antonio.

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