How DOACs Changed AFib Anticoagulation Management and Patient Follow-Up

In "How DOACs Changed AFib Anticoagulation Management and Patient Follow-Up," Dr. Barnes reflects on a decade of change in anticoagulation practice.

Dr. Barnes describes a real shift over the last decade or more in how anticoagulants are used for patients with atrial fibrillation. Before DOACs, warfarin was the only oral anticoagulant, and it demanded substantial health system resources. Many practices ran anticoagulation management services in which nurses or pharmacists managed each patient individually.

Under that model, patients came in every two to four weeks for a blood draw to check the INR, a measure of how thin the blood is. The team then adjusted the dose. Dr. Barnes calls it a very labor-intensive process.

With the switch to DOACs, and consistent growth in their use over the last 10 to 15 years, that repeated touchpoint is no longer required. Once the right dose is found, patients simply take it consistently. This has reduced health care resource utilization.

Dr. Barnes also identifies a secondary consequence. Patients are in touch with their health care providers far less often. On warfarin, the regular visits gave patients a checkpoint with a nurse, pharmacist, or prescriber. They could confirm they were still taking their medicines and ask questions.

With DOACs, most patients see their prescriber only every six months to a year. That visit checks kidney function and refills the medication. There is less opportunity to reinforce adherence, answer questions, or address concerns. Dr. Barnes calls the shift a two-way street.

Most importantly, he says, the transition has allowed clinicians to greatly expand the number of patients who receive oral anticoagulation for stroke prevention. The field is reaching many more patients than it did before. Those patients simply do not always have as much contact with the health care system.

The next episode in this series, "DOAC Dosing and Adherence in AFib: Barriers to Staying on Therapy," features Dr. Barnes detailing the four available DOACs and the challenge of adherence.