A pharmacist-led therapeutic interchange program successfully converted 44 of 193 eligible patients (22.8%) from vitamin K antagonists to direct oral anticoagulants, while 53.9% declined.
Observational (n=193)
Yes
Can a pharmacist-led intervention successfully convert eligible patients from vitamin K antagonists to direct oral anticoagulants, and what are the barriers to conversion?
A pharmacist-led screening and conversion program can successfully transition a portion of eligible patients from VKAs to DOACs, though patient preference and cost remain significant barriers to uptake.
Abstract 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.
Tran et al. (Wed,) conducted a observational in Patients on vitamin K antagonist therapy (n=193). Pharmacist-led therapeutic interchange from VKA to DOACs vs. Continuation of VKA therapy was evaluated on Successful conversion from VKA to a DOAC. A pharmacist-led therapeutic interchange program successfully converted 44 of 193 eligible patients (22.8%) from vitamin K antagonists to direct oral anticoagulants, while 53.9% declined.