Warfarin Workflows that Works​: Unifying Processes to Reduce Patient Risk ​

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Warfarin remains a widely used oral anticoagulant with a narrow therapeutic index, requiring consistent management to prevent bleeding or thromboembolic events. Evidence supports pharmacist‑led services as effective models for improving outcomes. In the Kaiser Permanente Colorado Clinical Pharmacy Anticoagulation Service, patients had a 39% lower risk of anticoagulation‑related complications and a significantly higher time in therapeutic range (TTR) compared with physician‑managed care. However, another study comparing pharmacist‑ and nurse‑managed workflows found higher TTR in the nurse‑managed group (71.2% vs 65.8%), while major bleeding and thromboembolic events were similar. Corewell Health, a newly formed statewide system in Michigan, currently lacks a standardized anticoagulation management process, prompting an evaluation of current practices.

This is a retrospective chart review of data from the Corewell Health electronic medical record. Current warfarin management processes across the organization will be mapped and compared with best practices from current literature, including pharmacist-managed models (CPAS, MAQI²), nurse-led anticoagulation services, and nurse/pharmacist collaborative-led clinics. Outcomes of interest include, but are not limited to, time in therapeutic range, adverse events (major bleeding or thromboembolic complications), process variation, and resource utilization. The study identified 3,949 unique patients of which a minimum powered sample was determined to be 1,716. Descriptive statistics and appropriate parametric or non-parametric tests will be used based on data distribution. Primary and secondary outcomes will be compared using ANOVA, Kruskal Wallis, chi-square, or descriptive methods with a significance level of 0.05.

Preliminary data collection is ongoing. Results will assess the degree of variation between workflows, identify gaps relative to published high-performing models, and quantify potential risks associated with process variability. These findings have the potential to impact clinical practice by pioneering a standardized approach to warfarin management for the system. Standardization translates into improved patient outcomes, a reduction in harm, and enhanced operational efficiency for clinical teams across the system.

Variability in anticoagulation management increases the risk of patient harm. By leveraging evidence within literature and studying our internal anticoagulation models, this project aims to unify Corewell Health's warfarin management practices into a single standardized process to improve safety, enhance efficiency, and align with system-wide quality goals.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1944

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