SEARCHCOHORTinternal medicine, cardiology

cohort·internal medicine, cardiology, hematology, surgery, clinical trial·PMC10322226

Potential for a Virtual Care Model in the Perioperative Management of Anticoagulant Therapy: A 5-Year Retrospective Clinic Review

TH Open: Companion Journal to Thrombosis and Haemostasis · 2 authors, 2 centres

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TL;DR

Eighty percent of patients had potential for virtual care, 13% could be managed with either model, and 7% would likely require in-person care.

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Eighty percent of patients had potential for virtual care, 13% could be managed with either model, and 7% would likely require in-person care. Single-center design, retrospective chart review limitations including potential misclassification, and the empiric nature of bleed-risk classification were noted.

STUDY TYPE

cohort

SPECIALTY

internal medicine

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100% · A

ORIGINAL PAPER

PMC10322226

Potential for a Virtual Care Model in the Perioperative Management of Anticoagulant Therapy: A 5-Year Retrospective Clinic Review

TH Open: Companion Journal to Thrombosis and Haemostasis

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ABSTRACT

Abstract Background With a trend toward greater virtual care in selected clinical settings, perioperative anticoagulant management appears well suited for this care delivery model. We explored the potential for virtual care among patients who are receiving anticoagulant therapy and require perioperative management around the time of an elective surgery/procedure. Methods We undertook a retrospective review of patients who were receiving anticoagulant therapy, either a direct oral anticoagulant (DOAC) or warfarin, assessed in a perioperative anticoagulation-bridging clinic over a 5-year period from 2016 to 2020. Using prespecified criteria, we determined the proportion of patients who likely would be suitable for virtual care (receiving a DOAC or warfarin and having a minimal- or low-/moderate-bleed-risk surgery/procedure), those who likely would be suitable for in-person care (receiving warfarin and requiring heparin bridging for a mechanical heart valve), and patients who would be suitable for either care delivery model (receiving a DOAC or warfarin, but not with a mechanical heart valve, and requiring a high-bleed-risk surgery/procedure). Results During the 5-year study period, there were 4,609 patients assessed for perioperative anticoagulant management in whom the most widely used anticoagulants were warfarin (37%), apixaban (30%), and rivaroxaban (24%). Within each year assessed, 4 to 20% of all patients were undergoing a minimal-bleed-risk procedure, 76 to 82% were undergoing a low-/moderate-bleed-risk surgery/procedure, and 10 to 39% were undergoing a high-bleed-risk surgery/procedure. The proportion of patients considered suitable for virtual, in-person, or either virtual or in-person management was 79.6, 7.1, and 13.3%, respectively. Conclusion In patients who were assessed in a perioperative anticoagulation clinic, there was a high proportion of patients in whom a virtual care model might be suitable. Keywords: virtual care, perioperative, anticoagulant, heparin bridging, warfarin, direct oral anticoagulants

CITATION EXPORT

James Luke Douketis, Sam Schulman. Potential for a Virtual Care Model in the Perioperative Management of Anticoagulant Therapy: A 5-Year Retrospective Clinic Review. TH Open: Companion Journal to Thrombosis and Haemostasis. (2023). https://doi.org/10.1055/a-2098-6782

AUTHORS

2 · 2 CENTRES

James Luke Douketis, Sam Schulman

1Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
2Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia