Anticoagulation Therapy in Managed Care

Managed care pharmacists involved in the care for patients at risk for thromboembolic disorders are routinely challenged with multiple sets of anticoagulation guidelines and protocols specific to their individual hospital, anticoagulation clinic, and/or third party payer settings.

This confusion can lead to unexpected barriers to care, disrupt communication between caregivers, and lead to inconsistency in the delivery of care. Evidence-based practices and consistent guidelines for screening, preventing, diagnosing, tracking, and treating thromboembolic disorders are needed, especially for patients at higher risk, to ensure that these practices are routinely applied by healthcare professionals in all settings.

One program at this year’s AMCP Annual Meeting, entitled “The Evolving Paradigm of Anticoagulation Therapy: Optimizing Managed Care Outcomes for Thromboembolic Disorders,” included a distinguished panel of key opinion leaders such as James B. Groce III, PharmD, Campbell University School of Pharmacy; Albert L. Waldo, MD, Case Western Reserve University School of Medicine; and Jeffrey D. Dunn, PharmD, MBA, SelectHealth.

Dr. Groce provided background on anticoagulation and stroke prevention. In addition, he discussed the impact of new agents on current and future guidelines and protocols. Dr. Groce included a case study of a patient on a direct thrombin inhibitor versus warfarin.

Dr. Waldo discussed the therapeutic advances for the management of thrombosis and methods for successfully navigating “the new paradigm.” Dr. Dunn concluded the session, stating that long-term anticoagulation is recommended for patients with atrial fibrillation (AF); however, only approximately 50% with AF receive regular anticoagulation, placing them at increased risk for stroke.

Dr. Dunn also pointed out that warfarin reduced risk and costs associated with stroke, but only if patients adhere to their medication regimen; advantages of oral anticoagulants such as direct thrombin inhibitors over warfarin included predictable therapeutic effect at fixed doses and limited drug-drug interactions (oral anticoagulants may also be more cost-effective in the prevention of ischemic stroke); and increasing availability of oral anticoagulants will require plans to restructure clinical and cost management policies and processes.