ACMS was developed to maximize care for patients requiring anticoagulant therapy. By monitoring clinical responses and providing ongoing patient education, the program aims to prevent unnecessary adverse drug effects associated with warfarin therapy. The goals of this service are threefold: 1) effectively manage patients’ anticoagulation therapy, 2) reduce the occurrence of adverse patient outcomes, and 3) lower total healthcare expenses.
The anticoagulation case management service (ACMS) is a component of the University of Iowa Hospitals and Clinics Ambulatory Care Pharmacy division. The clinic is staffed by pharmacists with collaborative practice agreements with UIHC physicians (primarily family medicine and internal medicine). The pharmacists independently monitor patients’ anticoagulation (e.g. warfarin, enoxaparin) and make dosage adjustments as deemed appropriate. During each visit, patients are evaluated for signs and symptoms of blood clots (thromboembolism) and bleeding (hemorrhage). Drug and diet therapies are reviewed to identify drug-drug, drug-food, and drug-disease state interactions that may affect the patient’s anticoagulant therapy. When indicated, a lab test (i.e., INR) is ordered to assess the patient’s level of anticoagulation.
- Atrial fibrillation/flutter
- Deep venous thrombosis (DVT) and pulmonary embolism (PE)
- Heart valve replacement
- Left ventricular assist devices
- Left ventricular thrombus
- Peripheral vascular disease
- Miscellaneous indications requiring warfarin therapy