Impact of an Initiative to Improve the Administration of Anticoagulation in High-Risk Patients

摘要

High-risk warfarin usage, as defined by a time in thera- peutic range ( T TR) of less than 65%, has been associ- ated with an increased risk of stroke, systemic embolization, major bleeding, and mortality. 1 Direct oral anticoagulants (DOACs) have previously been demonstrated to be both a cost-effective alternative and associated with a greater re- duction in rates of stroke, systemic embolization, and ma- jor bleeding for the treatment of nonvalvular atrial fibrilla- tion (AF) and venous thromboembolism (VTE) compared with warfarin. 2 , 3 In addition, DOACs are recommended as first-line initial therapy for both indications by major clini- cal guidelines. 4 , 5 Previous real-world cost data have further suggested that a switch from warfarin to apixaban would re- sult in an estimated total medical cost avoidance of $4,440 per patient-year.