Optimizing Anticoagulation: Evaluation of a Nurse-Led Warfarin Management Protocol in the Ambulatory Care Setting

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Warfarin is an oral anticoagulant requiring close monitoring for efficacy and safety through the use of the international normalized ratio (INR). Nurse-managed warfarin clinics are utilized across many institutions to provide care for patients to decrease provider burden. The Corewell Health West Anticoagulation Clinic patients on warfarin are managed by nurses via the "Warfarin Management Protocol - Ambulatory" protocol. This allows nurses to adjust warfarin dose, bridge with enoxaparin, monitor INR, and prescribe vitamin K (phytonadione). There has not been an evaluation of the efficacy and safety of this protocol to date. This study aims to evaluate the overall efficacy and safety of our nurse-managed warfarin clinic at current state.

This is a retrospective descriptive study of 1,144 patients who received care at the anticoagulation clinic between September 2nd, 2024 and September 2nd, 2025. Included patients were 18 years or older, prescribed warfarin for any indication, and have an "Anti-coag visit" encounter at the Bradford clinic. Excluded patients had a left ventricular assist device or were pregnant. The primary endpoint is protocol efficacy as determined by average time in therapeutic range (TTR), number of INRs per patient, and quantity of anti-coagulation visits per patient. Secondary safety measures include bleeding or clotting events, vitamin K orders, and emergency room or hospital presentations related to warfarin during the study period. A subgroup of 150 randomly selected encounters evaluated the quantity of EPIC communications per encounter and the percentage of matching warfarin dose instructions between visit notes and prescriptions. Descriptive statistics will be used to evaluate these endpoints.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1983

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