ABSTRACT
Background: Dedicated anticoagulation clinics have demonstrated superior patient outcomes. The COVID-19 pandemic created challenges for patient care including fear of medical appointments due to potential risk of exposure. An innovative approach to anticoagulation management was developed at our center that allows the patient to stay in their vehicle while our anticoagulation advanced practice nurse obtains blood for point-of- care/ INR testing, education and counseling. Objectives: 1. To assess degree of compliance to anticoagulation management pre vs. post drive-through clinic. 2. Assess percentage and time to therapeutic range (TTR), percentage within therapeutic (TR), subtherapeutic, and supratherapeutic INR pre vs. post drive-through clinic. 3. Evaluate bleeding and thrombosis complications during study period. 4. Assess patient/family satisfaction. Methods: Retrospective chart review of patients on warfarin therapy who used the drive-through clinic between April 1 and August 31, 2020. Patient demographics, underlying diagnosis, and target INR range were reviewed. Dates and values for INR, percentage of therapeutic (TR), subtherapeutic, and supratherapeutic INR and degree of compliance (≥1 INR determination per month) were collected for 6 months prior to April 1 and compared to results obtained during drive-through clinic implementation. Data were summarized descriptively and compared using nonparametric statistical methods. Results: A total of 17 patients were evaluated in our drive-through clinic during the study period. Fifty-eight percent were males (n = 10) with a median age of 15 years (range: 3-54). Primary indication for warfarin therapy included: tricuspid valve replacement (n = 1), mitral valve (n = 5), aortic valve (n = 4), Fontan (n = 5), atrial fibrillation (n = 1), and deep vein thrombosis (n = 1). Median TTR was 60.1% (range: 21.1-89.2) with a median cumulative time of anticoagulation of 3.3 years (range: 0.2-6.1 years). Overall compliance pre vs. post drive-through clinic implementation was similar (median pre compliance 100% (95% CI: 83%-100%) vs. 100% post (95% CI: 100%-100%);p = 0.16;Figure 1). Five of six patients who had compliance less than 90% achieved an improvement with the drive-through clinic. The median percentage of INR within TR improved significantly with the drive-through clinic (median pre 50% (95% CI: 33%-67%) vs. median post 80% (95% CI: 57%-100%);p = 0.0103;Figure 2). No bleeding or thrombotic complications were observed. Patients and families reported 100% satisfaction with the drive-through care. Conclusions: A drive-through INR clinic during COVID-19 pandemic allowed patients to access care from their vehicle. A subgroup of patients improved compliance to INR monitoring. The median percentage of INR within TR improved significantly after implementation of the drive-through clinic. Innovative approaches such as this clinic may improve patient compliance and adherence to anticoagulation. (Figure Presented).