Outpatient anticoagulation management services may play an important supportive role in the care of patients with hemophilia and other diseases, according to a commentary published in Research and Practice in Thrombosis and Haemostasis.

The commentary was written by Bethany Samuelson Bannow, MD, from the Hemophilia Center at Oregon Health and Science University in Portland.

When direct oral anticoagulants were first approved by the FDA, there was some excitement among the medical community because they required neither routine monitoring nor frequent dose adjustment. Direct oral anticoagulants continue to be used today, providing greater safety over vitamin K antagonists in some instances. 

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Studies have highlighted some of the benefits of prescribing and monitoring direct oral anticoagulants in an outpatient anticoagulation management service. The key finding is that it can relieve some of the burden on the healthcare system, especially since many healthcare systems are still experiencing the residual challenges of managing patients with COVID-19. 

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“Specific services provided for [direct oral anticoagulant] patients include dose adjustments, procedure planning, assessment of adherence, assessment for bleeding/recurrent thromboembolism, side effects, new medications/interactions, and periodic laboratory assessment for changes in renal or liver function,” Dr. Bannow wrote on the functions of outpatient coagulant management services. 

Direct oral anticoagulants can also be used in a wide range of diseases, including atrial fibrillation, venous thromboembolism, cancer-associated thrombosis, and preventing the occurrence of ischemic events after percutaneous coronary intervention in cases of atrial fibrillation. 

Dr. Bannow suggested that patients who are indicated for outpatient anticoagulation management services be clearly identified as such. The main purpose, as alluded to earlier, is to reduce the burden on existing healthcare infrastructures. 

“Patients taking [direct oral anticoagulants] may benefit from the services of an [outpatient anticoagulation management services], and wider, integrated use of such services in combination with other supports, has the potential to reduce clinician/physician burnout,” Bannow concluded. 


Samuelson Bannow B. Are outpatient anticoagulation management services the wave of the future (again)?) Res Pract Thromb Haemost. 2022;6(4):e12735. doi:10.1002/rth2.12735