COMPARISON OF AN ANTICOAGULATION CLINIC WITH USUAL MEDICAL-CARE - ANTICOAGULATION CONTROL, PATIENT OUTCOMES, AND HEALTH-CARE COSTS

Background: The outcomes of an inception cohort of patients seen at an anticoagulation clinic (AC) were published previously. The temporary closure of this clinic allowed the evaluation of 2 more inception coho rts: usual medical care and an AC. Objective: To compare newly anticoa gulated patients who were treated with usual medical care with those t reated at an AC for patient characteristics, anticoagulation control, bleeding and thromboembolic events, and differences in costs for hospi talizations and emergency department visits. Results: Rates are expres sed as percentage per patient-year. Patients treated at an AC who rece ived lower-range anticoagulation had fewer international normalized ra tios greater than 5.0 (7.0% vs 14.7%), spent more time in range (40.0% vs 37.0%), and spent less time at an international normalized ratio g reater than 5 (3.5% vs 9.8%). Patients treated at an AC who received h igher-range anticoagulation had more international normalized ratios w ithin range (50.4% vs 35.0%), had fewer international normalized ratio s less than 2.0 (13.0% vs 23.8%), and spent more time within range (64 .0% vs 51.0%). The AC group had lower rates (expressed as percentage p er patient-year) of significant bleeding (8.1% vs 35.0%), major to fat al bleeding (1.6% vs 3.9%), and thromboembolic events (3.3% vs 11.8%); the AC group also demonstrated a trend toward a lower mortality rate (0% vs 2.9%; P=.09). Significantly lower annual rates of warfarin sodi um-related hospitalizations (5% vs 19%) and emergency department visit s (6% vs 22%) reduced annual health care costs by $132 086 per 100 pat ients. Additionally, a lower rate of warfarin-unrelated emergency depa rtment visits (46.8% vs 168.0%) produced an additional annual savings in health care costs of $29 972 per 100 patients. Conclusions: A clini cal pharmacist-run AC improved anticoagulation control, reduced bleedi ng and thromboembolic event rates, and saved $162 058 per 100 patients annually in reduced hospitalizations and emergency department visits.