American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists · 2026
Evaluating direct oral anticoagulant candidacy and pharmacist-led conversion of eligible patients on vitamin K antagonist to direct oral anticoagulants.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Tran Brian B, Streiff Michael B
Аннотация
PURPOSE: Since the initial approval of direct oral anticoagulants (DOACs), multiple studies have concluded that DOACs were either noninferior or superior to vitamin K antagonist (VKA) for treatment of venous thromboembolism and prevention of cardioembolic stroke with less incidence of bleeding. Therefore, the objectives of this study were to identify eligible patients on VKA, conduct pharmacist-led therapeutic interchange from VKA to DOACs, and identify reasons for declining conversion.
METHODS: This multicenter, prospective study was conducted at anticoagulation clinics at the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center between July 2024 and July 2025. The first phase focused on screening for DOAC candidacy using a peer-reviewed DOAC conversion algorithm. The second phase consisted of prospective conversion of eligible patients from VKA to a DOAC. If patients declined conversion, the reason they declined was documented.
RESULTS: A total of 496 patients were seen in the anticoagulation clinics of the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center at the time of enrollment. Of the 193 eligible patients who were included in the study, 69 (35.8%) patients agreed to conversion, 104 (53.9%) declined conversion, 10 (5.2%) were lost to follow-up, and 10 (5.2%) were waiting to discuss conversion with their anticoagulation clinic provider. A total of 44 (22.8%) patients were successfully converted from VKA to a DOAC. Of the patients who declined conversion, 55 reported a preference for VKA therapy and 49 identified cost as a reason for declining conversion.
CONCLUSION: Although most patients in both anticoagulation clinics remained on VKA therapy, a large proportion of patients were eligible to convert to DOACs. This study provides a framework for pharmacist-led VKA to DOAC conversions, which can be conducted on an annual basis.
METHODS: This multicenter, prospective study was conducted at anticoagulation clinics at the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center between July 2024 and July 2025. The first phase focused on screening for DOAC candidacy using a peer-reviewed DOAC conversion algorithm. The second phase consisted of prospective conversion of eligible patients from VKA to a DOAC. If patients declined conversion, the reason they declined was documented.
RESULTS: A total of 496 patients were seen in the anticoagulation clinics of the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center at the time of enrollment. Of the 193 eligible patients who were included in the study, 69 (35.8%) patients agreed to conversion, 104 (53.9%) declined conversion, 10 (5.2%) were lost to follow-up, and 10 (5.2%) were waiting to discuss conversion with their anticoagulation clinic provider. A total of 44 (22.8%) patients were successfully converted from VKA to a DOAC. Of the patients who declined conversion, 55 reported a preference for VKA therapy and 49 identified cost as a reason for declining conversion.
CONCLUSION: Although most patients in both anticoagulation clinics remained on VKA therapy, a large proportion of patients were eligible to convert to DOACs. This study provides a framework for pharmacist-led VKA to DOAC conversions, which can be conducted on an annual basis.