Impact of an Inpatient Anticoagulation Management Service on Clinical Outcomes

Anticoagulants are effective in theprevention and treatment of throm-bosis, but they are, by nature, high-risk medications with narrow therapeutic tar-gets. Interindividual differences in drug metabolism, comorbid illnesses, and use of interacting medications can signifi-cantly influence the intensity of antico-agulant effect and the risk of bleeding complications.1 National hospital accred-itation organizations and patient safety groups have highlighted the risks associ-ated with the use of anticoagulants and have actively promoted the need for healthcare institutions to develop strate-gies to improve the safe use of these drugs.2,3 Evidence exists that there are clinical and financial benefits of special-ized anticoagulation management ser-vices, yet most of these studies have fo-cused on outpatients.4-9 Nevertheless, substantial need for anticoagulation con-sultative services also exists among hos-pital inpatients who are at higher risk for poor anticoagulation control and antico-agulation-associated adverse effects.10 This assessment is particularly relevant for postoperative inpatients who are at the highest risk for bleeding and throm-botic complications.11,12 Consequently, we established an inpatient anticoagulation management service (AMS) that focuses on cardiac surgery inpatients who often require anticoagulation and are at high risk for bleeding complications due to the nature and location of their surgical procedures. The objective of this study was to determine the impact of the AMS on clinical outcomes in cardiac surgery inpatients receiving warfarin