Outpatient management of deep vein thrombosis using direct oral anticoagulants is safe and efficient

Direct oral anticoagulants (DOACs) are increasingly becoming the treatment of choice for venous thromboembolism (VTE). To ensure safe prescription and prevent delay of supply for dischargeable patients with deep venous thrombosis (DVT) presenting to the Emergency Department (ED) outside pharmacy hours, we implemented a “Rivaroxaban after‐hours pack” system, that requires prescribers to assess suitability via criteria detailed in a decision support system GuidanceMS, prior to pack provision. Pharmacist and clinic follow up is also provided. To assess the safety and effectiveness of the program, a retrospective case series review was undertaken of DVT patients discharged from the ED with an after‐hours pack from April 2015 to December 2017. Patients were assessed for compliance with recommendations for treatment from their baseline demographics, biochemistry, medication history, bleeding and thrombotic risk. Any bleeding episodes or clot extension were recorded. The number of admissions for hospital DVT treatment for the study period was compared to the preceding 30 months. Of the 120 patients reviewed, all patients had adequate renal function, 96.3% had liver function tests <3× the upper limit normal. Three patients (2.5%) had active malignancy and no patients had a mechanical valve or antiphospholipid syndrome. All patients received a pharmacist telephone follow‐up education conversation and referral to Thrombosis Outpatients. Twelve patients reported clinically relevant non‐major bleeding, while two patients had clot extension despite compliance. There was marked reduction in hospital and/or hospital‐in‐the‐home admissions compared to the previous 30 months (P< 0.001). In conclusion, all DVT patients were safely prescribed Rivaroxaban using this system, with a reduction in hospital and/or hospital‐in‐the‐home admissions. This system is efficient in ensuring safe provision of Rivaroxaban outside of pharmacy hours, with potential for extension to the primary care setting.