Abstract Number: PB1077
Meeting: ISTH 2021 Congress
Background: The COVID-19 pandemic disrupted anticoagulation clinics with staff re-deployment and patient fears of exposure when getting INR testing. The impact on quality metrics of INR control, timeliness of INR testing, and strategies to mitigate barriers are not well described.
Aims: To compare time in therapeutic range (TTR), prescribed interval for next INR, proportion of late INRs, use of extended INR testing > 5 weeks, switch from warfarin to a direct oral anticoagulant (DOAC) and use of home INR testing before and after the beginning of the pandemic in March 2020.
Methods: Pre/post comparison of patients in the ongoing MAQI2 quality collaborative registry of 6 anticoagulation clinics in the USA funded by an insurance provider, Blue Cross/Blue Shield of Michigan. Patients initiating warfarin are retrospectively reviewed by trained nurse abstractors. Continuous data was compared with student t-test and categorical with chi square.
Results: The number of patients post pandemic did not change and data in the table reflects delays in abstraction secondary to nurse re-deployment. There was no change in TTR, and the proportion of patients with late INRs (>1 day overdue) increased by 1%. There was no change in timeliness contacting patients with INR results, and prescribed next INR increased by 1 day. Use of extending testing intervals increased by 1%, switching from warfarin to DOAC decreased by 2% and there was no change in the proportion of patients using home INR testing.
|Pre-pandemic (September 2019-February 2020)||Pandemic (March 2020-August 2020)||P-value|
|Number of patients||2,527||1,716||–|
|Number of follow-ups||23,196||12,453||–|
|Time in therapeutic range (%)||62.9%||62.8%||0.56|
|INRs retested > 1 day late (%)||7,717 (33.3%)||4,275 (34.3%)||0.04|
|Time from INR result to patient contact (mean days±SD)||0.78±1.58||0.78±1.68||0.69|
|Prescribed INR retest intervals (mean days±SD)||14.2±12.3||15.4±13.7||<0.001|
|Use of extended testing interval in patients (%)||1,087 (4.7%)||708 (5.7%)||<0.001|
|Pts switched to a DOAC (#/100 pts followed)||108 (4.3%)||41 (2.4%)||0.001|
|Home testers (#/100 pts followed)||340 (13.5%)||234 (13.6%)||0.86|
Conclusions: We saw no change in INR control or timeliness of patient contact and only slight delays in patient follow up. There was minimal uptake in suggested strategies to mitigate the need for INR testing. Our anticoagulation clinics performed admirably during the pandemic.
To cite this abstract in AMA style:Kaatz S, Kong X, Haymart B, Ali M, Kline-Rogers E, Krol G, Shah V, Kozlowski J, B Froehlich J, D Barnes G. Quality of INR Control during the COVID-19 Pandemic [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/quality-of-inr-control-during-the-covid-19-pandemic/. Accessed November 27, 2021.
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