Background: Dedicated anticoagulation programs have demonstrated improvement in patients’ anticoagulation management and outcomes. Our anticoagulation program, established in 2014, is unique as it provides comprehensive care to pediatric and adult patients expanding diverse geographical areas in the state of Ohio.
Aims: (1) Compare the impact of an anticoagulation program pre- and post-implementation, on the quality of anticoagulation as measured by % time in therapeutic range (%TTR) and compliance.
(2) To assess clinical outcomes (bleeding and thrombosis complications) prior and following anticoagulation program implementation.
Methods: Medical records were retrospectively reviewed for the years 2014-2019. Patient demographics, indications and type of anticoagulants, INR range, days on anticoagulation, TTR, % TTR and compliance were obtained. Percentage TTR was calculated by Rosendaal linear interpolation method. Bleeding complications were defined according to the ISTH-SSC for non-surgical patients. New thrombotic events were reviewed. Comparisons were made using non-parametric analyses.
Results:
| Long-term warfarin patients Male sex Median age, years (range) Age group Pediatrics (<18 y) Adults |
N=308 180 (58.4) 24 (2 – 69) 91 (29.5) 217 (70.5) |
| Warfarin indication Mechanical valve Fontan DVT/PE Atrial fibrillation/flutter Other (heart failure, pulm. HTN, etc.) |
161 (52.3) 55 (17.9) 45 (14.6) 31 (10.1) 16 (5.2) |
| Home INR | 44 (14.3) |
| Aspirin | 155 (50.3) |
| Bleeds pre-clinic Major Non-major/minor |
7 (2.3) 3 (1.0) |
| Bleeds while followed by clinic Major Non-major/minor |
17 (5.5) 25 (8.1) |
| Venous thromboembolic events VTE pre-clinic VTE while followed by clinic |
6 (1.9) 8 (2.6) |
| Non-warfarin long-term or short-term warfarin patients Median age at VTE, years (range) Age Group Pediatrics (<18y) Adults |
N=114 16 (0 – 45) 98 (86.0) 16 (14.0) |
| Major/Minor bleeds | 9 (7.9) |
| VTE events while on anticoagulation | 0 |
Median TTR % pre-clinic was 17.5%, vs the median TTR % post-clinic was 87%; patients increased their TTR % by 63% on average p<0.0001
Table 1 summarizes demographic data. Long-term warfarin therapy group included 308 patients with 87% of these being cardiac related indications. Median age 24 y (range: 2-69 y). The second group (N=114) comprised short-term and non-warfarin long-term anticoagulation (e.g. LMWH, DOAC) [median age 16 (range: 0-45 y)].Median %TTR pre-anticoagulation clinic for 26 patients was 17.5% versus median TTR post-clinic of 87% (Fig 1A). Median %TTR 81.2 (range: 77.7-85.4) for the years 2014-2019. Similarly, compliance increased by an average of 28.6%. Thrombosis events while on anticoagulation was no different pre- and post-clinic (Table 1; p= 0.59). Bleeding events were higher post-clinic [N=17; mean age 35 y (range: 22-69 y)] versus pre-clinic [N=7; mean age 25.8 (range: 2-69 y)].
Conclusions: Our anticoagulation program has significantly improved and sustained %TTR and compliance. A greater proportion of major bleeding events were documented post-clinic implementation perhaps related to the increased age and complexity of our patient population.
To cite this abstract in AMA style:
Rodriguez V, Stanek J, Giver J, Dunn A, Sankar A, Monda K, Canini J, Kerlin B. Nationwide Children’s Hospital Pediatric and Adult Comprehensive Anticoagulation Program: A Report on its Anticoagulation Management and Clinical Outcomes [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/nationwide-childrens-hospital-pediatric-and-adult-comprehensive-anticoagulation-program-a-report-on-its-anticoagulation-management-and-clinical-outcomes/. Accessed November 29, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/nationwide-childrens-hospital-pediatric-and-adult-comprehensive-anticoagulation-program-a-report-on-its-anticoagulation-management-and-clinical-outcomes/