Structure and function of a perioperative anticoagulation management clinic
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BACKGROUND: The perioperative management of patients who are receiving an anticoagulant and require a surgery/procedure is well-informed by multiple clinical studies, but an assessment of the delivery of such management is lacking. Describing the structure and function of a perioperative anticoagulation clinic provides a model for delivery of such patient care. METHODS: We examined the operational model of a perioperative anticoagulation clinic. We describe the processing and management of patients receiving anticoagulant therapy who require elective surgery or procedure, including anticoagulant interruption, resumption and consideration for bridging therapy. We also describe the patient profile assessed over an 18-month period, and the potential benefits of this clinic to patients for perioperative management and education. RESULTS: During an 18-month period, 1061 patients were assessed. Atrial fibrillation and venous thromboembolism were the most common indications for anticoagulant therapy, comprising 55.0% and 26.5% of patients, respectively; 44.1% of patients were taking warfarin, 37.1% were taking direct oral anticoagulants, and 12.3% were receiving low-molecular-weight heparin. The key components of this clinic model emphasizes a patient-centered approach to perioperative anticoagulant management based on evidence-based management protocols, alongside patient and family education that is delivered by a multi-disciplinary team approach. CONCLUSIONS: Our perioperative anticoagulation clinic model provides one approach to the delivery of perioperative anticoagulant management, with the potential to optimize patient safety, improve patient education, and minimize health care costs.
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