LAUSR

Warfarin had long been the sole oral anticoagulant until the advent of direct oral anticoagulants (DOACs). Improving the management of warfarin is an important goal because warfarin, or any anticoagulant, has the potential to cause great harm to patients if not managed closely. A well-established metric for measuring the quality of anticoagulation control for warfarin is percent time in therapeutic range (TTR) . Although calculating TTR is seemingly straightforward, there are many challenges when implementing a standardized methodology across a large, integrated healthcare system. In the Department of Veterans Affairs (VA), most warfarin therapy is managed by pharmacists (86%). However, the structure of care ranges from a centralized, telephone-based anticoagulation clinic to decentralized, face to face integration of anticoagulation therapy within a primary care pharmacist’s duty as part of the VA’s patient-centered medical homemodel. There was a lack of reports tomeasure and compare the quality of anticoagulation control using TTR across these varied practices.