the start of the study period. Furthermore, this study was not powered to
detect significant differences in safety
or efficacy outcomes. Other potential study limitations included having national VA guidance regarding
follow-up periods and dabigatran
prescription quantity limits during
both study periods. Also, there was
some potential for pharmacist-initi-ated refills at follow-up visits, which
could falsely increase MPR. Last, the
study analyzed only 1 DOAC and
not the entire class of medications.
Centralizing DOAC management
by clinical pharmacy specialists at
a single VA facility helped maintain
high rates of dabigatran adherence,
above the national average, and
low rates of adverse outcomes were
maintained in both study groups. In
addition, centralization of anticoagulation services improved access
to care through an increase in primary care pharmacist visits without
the addition of staff. Centralization
of DOAC management by pharmacists is a viable option for maintaining high rates of adherence and low
rates of adverse outcomes in facilities
where the goal is to achieve clinical
The authors report no actual or potential conflicts of interest with regard to
The opinions expressed herein are those
of the authors and do not necessarily
reflect those of Federal Practitioner,
Frontline Medical Communications
Inc., the U.S. Government, or any of its
agencies. This article may discuss unlabeled or investigational use of certain
drugs. Please review the complete prescribing information for specific drugs
or drug combinations—including indications, contraindications, warnings,
and adverse effects—before administering pharmacologic therapy to patients.
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