Some patients experience difficulty obtaining necessary outpatient prescription drugs ordered upon inpatient discharge due to a variety of barriers such as drug cost, insurance plan drug restrictions, drug recalls and shortages, etc. These barriers to drug access can result in a delay of therapy initiation, nonadherence to medications or a lack of medication acquisition altogether which can increase the risk of adverse drug events and hospital readmission. This guide was developed to assist facility discharge planning staff in identification and resolution of post-discharge prescription drug accessibility problems.
Created by the members of the Peri-Procedural Task Force of the NYS Anticoagulation Coalition and IPRO, this guide is intended to:
Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis
Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant “bridging”
Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period
Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures
Please note: The content of this tool was last updated May 2014 and the current version may not reflect recently published evidence. A revision is pending. Please refer to the following citations and other recent publications for more information:
Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy. American College of Chest Physicians – CHEST Journal. 2012;141(2):e326S-50S.
Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood. 2012 Oct 11;120(15):2954-62.
Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015 Aug 27;373(9):823-33.
Clark NP, Witt DM, Davies LE, et al. Bleeding, recurrent venous thromboembolism, and mortality risks during warfarin interruption for invasive procedures. JAMA Intern Med. 2015 Jul;175(7):1163-8.
Mathew JG, Spyropoulos AC, Yusuf A, et al. Efficacy and safety of early parenteral anticoagulation as a bridge to warfarin after mechanical valve replacement. Thromb Haemost. 2014 Dec;112(6):1120-1128.
Baron TH, Kamath PS, McBane RD. Management of antithrombotic therapy in patients undergoing invasive procedures. N Engl J Med. 2013 May 30;368(22):2113-2124.
Heidbuchel H, Verhamme P, Ailings M, et al. Updated european heart rhythm association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular trial fibrillation. Europace Journal. 2015 Aug 31.
Siegal D, Yudin J, Kaatz S, et al. Periprocedural heparin bridging in patients receiving vitamin K antagonists. American heart association. 2012 Aug 21;126:1630-39.
A unique audit tool aimed at reducing anticoagulant-related adverse drug events (ADEs) during care transitions, IPRO’s Anticoagulation Discharge Communication tool evaluates the communication of 17 essential anticoagulation-related information elements to “downstream” healthcare providers upon patient discharge and transfer, highlighting potential system flaws and guiding improvements in communications.
Multiple groups and organizations have endeavored to develop and define “best practices” relating to high quality anticoagulation management. Additional resources to drive improvements in anticoagulation care are available through the following sites and groups:
A multidisciplinary nonprofit organization of health care professionals seeking to improve the quality of care for patients taking antithrombotic medications.
A non-profit, voluntary health organization dedicated to advancing the prevention, early diagnosis and successful treatment of life-threatening blood clots.
- ACCP Antithrombotic Guidelines, 9th Edition
More than 600 recommendations for the prevention, diagnosis, and treatment of thrombosis
The Centers of Excellence program offers an assessment tool to determine if your anticoagulation service is operating at the highest level, with recommendations and resources provided for specific areas that can be improved; and a comprehensive, searchable resource center that provides the guidelines and tools to improve towards excellence.
An affiliate of the NYS Health Facilities Association, Inc. (NYSHFA), the Foundation for Quality Care offers an archive of presentations by Dr. Elaine Hylek and Dr. Darren Triller that support warfarin safety in skilled nursing facilities.
The American Medical Directors Association offers the 2012 revision of the Antithrombotic Therapy in the Long Term Care Setting Information Tool Kit, which is intended to help practitioners optimally manage the use of antithrombotic therapies in elderly patients in the LTC setting. The manual incorporates evidence-based guidelines and expert opinion from several specialty organizations, including the American College of Chest Physicians American College of Cardiology, American Heart Association, and the American Stroke Association.