Postoperative Warfarin Re-Initiation Strategies: an Interview-Based Comparison of Certified Anticoagulation Providers

Abstract

Specific Aims: The purpose of this study is to identify a postoperative warfarin re-initiation protocol used most commonly by certified anticoagulation providers. Our main hypothesis is that certified Anticoagulation providers use a postoperative warfarin re-initiation strategy based upon clinical experience/knowledge as opposed to a guideline-based approach. Methods: The Anticoagulation Forum website will be used to select the anticoagulation providers to interview via telephone. The selection process will be as follows: an excel spreadsheet will be created separating every clinic listed on the website by region, then fifty anticoagulation providers will be randomly selected by utilizing a random number generator function in excel for each region. Anticoagulation providers are listed on the website by region, and then further broken down by states in that region. The intention of separating regions is to attain equal representation of anticoagulation providers across the United States that are listed on the Anticoagulation Forum website. Anticoagulation providers will be called during the months of July, August and September 2012. Any anticoagulation provider contacted that is not certified with the National Certification Board for Anticoagulation Providers (NCBAP) as well as services or clinics not listed on the Anticoagulation Forum website will be excluded. An application will be submitted to the University of Arizona Institutional Review Board (IRB) Human Subjects Protection Program for approval of this study. We plan to randomly call 50 anticoagulation providers from each region of the US listed on the Anticoagulation Forum website. Thus, total estimated sample size is approximately 300 providers. The primary dependent variable is the postoperative warfarin re-initiation protocol. Our demographic variables are as follows: # of years in anticoagulation practice, gender of the provider and their credentials. The data extraction form is comprised of 3 parts. Part 1 will focus on questions directly related to the anticoagulation service, part 2 is for describing the patient population served and part 3 will be related to the provider demographic characteristics. Data will be collected by utilizing a telephone interview questionnaire-based approach. Each certified anticoagulation provider randomly selected from the Anticoagulati Main Results: The information about warfarin re-initiation dose and protocol information are shown in Table 2. A majority of certified anticoagulation providers re-initiate warfarin at the same dose (64%) after temporary interruption compared to a relative warfarin dose (36%) following surgery/procedure. Likewise, more certified anticoagulation providers have a protocol in place (59%) compared to no protocol in place (41%). Conclusion: This study displayed strength when certified anticoagulation providers were able to be contacted and take the time to answer the questionnaire. Certified anticoagulation providers utilize a common warfarin re-initiation strategy. Most providers’ re-initiation warfarin at the same dose at which the patient was receiving prior to surgery. However, there are many other factors that may go into making the decision of which warfarin dose to use postoperatively.