Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting

Background: Anticoagulation management by a dedicated anticoagulation clinic improves patient outcomes compared to routine medical care. Telepbone-based anticoagulation management has been described but has not been compared to management with traditional office-based Visits. The objective of this study was to compare warfarin-related monitoring outcomes, clinical end points, and the use of health-care resources as a result of warfarin-related complications in anticoagulation clinic patients whose management was conducted by telephone or in-office-based Visits. Setting: Two university-affiliated anticoagulation clinics in Seattle, WA, and Chicago, IL. Methods: A retrospective, observational cohort design was used to investigate anticoagulation clinic patients who were managed by telephone encounters compared to those managed during face-to-face in-office encounters. Results: A total of 234 patients were evaluated; 117 patients managed by telephone were compared to 117 patients managed in office-based clinic visits. Monitoring outcomes (ie, time in therapeutic range and clinic visits per patient-year) were similar between groups. Differences in major bleeding (5.67% vs 5.62% per patient-year, respectively) and thromboembolic events (1.42% vs 2.81% per patient-year, respectively) between telephone-managed and face-to-face-managed patients did not reach statistical significance. The same was true for differences in the frequency of emergency department visits and hospital admissions to manage complications of warfarin therapy. Conclusions: Telephone-based management of oral anticoagulation through a pharmacist-staffed anticoagulation clinic yielded clinical outcomes that were at least as favorable as those associated with traditional office-based visits. Telephone follow-up can he successfully used to manage warfarin therapy in patients who are unable to present in person to an anticoagulation clinic.