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Outpatient evaluation of hemoglobin monitoring frequency in patients on anticoagulation therapy
Thursday April 24, 2025 12:00pm - 12:15pm EDT
Parthenon 1
Primary Investigator: Liana Ha
Co-investigators: Saira Mirza; Alyssa Utz; Salman Hasham; Mikhail Y. Akbashev 
Background: 
Anticoagulation therapy is used for a variety of indications, such as treatment of thromboembolism, prevention of stroke in atrial fibrillation, in critically ill patients, and other patients with hypercoagulable states. Anticoagulation therapy is considered high-risk, and the main risk associated with use is bleeding. The International Society of Thrombosis and Hemostasis defines major bleeding as fatal bleeding, bleeding associated with a decrease in hemoglobin (Hgb) of >2 g/dL, or bleeding associated with a critical anatomical site. Routine complete blood count (CBC) screening has shown utility in detecting occult bleeds before becoming severe or major bleeding. There is no clear designation on how often anticoagulation patients should be seen in clinic or have their CBC monitored, and it is not clear if this affects their bleeding risk. It is also unclear how risk factors for bleeding, such as chronic conditions and medication use, affect how often a person needs to be monitored. Further investigation into Hgb monitoring intervals may help guide clinicians on more effective lab ordering and patient monitoring. The purpose of this study is to compare outpatient Hgb monitoring intervals of less than and more than a year in patients on anticoagulation.
Methods: 
This IRB-exempt study was a single-center, retrospective chart review of adult patients receiving anticoagulation therapy from our institution’s outpatient pharmacies between January 2017 – March 2023. The patient list was obtained from the electronic health record. Patients were included if they were at least 18 years of age, had at least two Hgb labs collected at least half a day apart, and had a decrease of hemoglobin of at least 2 g/dL. Patients were excluded if they were on anticoagulation therapy for less than a year or not on anticoagulation therapy at the time the Hgb was collected. The primary outcome was the incidence of patients with a decrease of > 2 g/dL in Hgb and monitored less frequently than annually. Secondary outcomes included the incidence of Hgb < 7g/dL, bleeding at a critical site, symptomatic bleeding, and requiring blood transfusions. 
Results:
Of the 7254 hemoglobin labs screened, 196 Hgb values were included in the final analysis. Of the 196 Hgb values, 82% (n=160) were monitored more frequently than annually and 18% (n=36) were monitored greater than a year apart. Of the values that were collected less than a year apart, 41% (n=81) were collected less than 91 days apart, 22% (n=42) were collected between 91-180 days apart, 14% (n=27) were collected between 181-270 days apart, and 5% (n=10) were collected between 271-365 days apart. 
When comparing Hgb results that were measured greater than a year apart to less than a year apart, patients that were monitored more frequently experienced a greater mean difference in hemoglobin values (-3.17 vs -2.78, p=0.066), were more likely to have blood transfusions (13% vs 8%, p=0.482), and were more likely to have a hemoglobin of less than 7 g/dL (9% vs 0%, p=0.056). Patients that were monitored less frequently experienced more symptomatic bleeding (36% vs 31%, p=0.522). No patients in either group experienced bleeding at a critical site. 
Conclusion:
In conclusion, patients on anticoagulation therapy with a decrease in hemoglobin of at least 2 g/dL were more likely to have their outpatient hemoglobin monitored more frequently than annually. Hemoglobin monitoring frequency of less than annually was associated with a greater likelihood of occult anemia. 


Moderators
GA
Presenters
LH
LH

Liana Ha

PGY-1 Pharmacy Resident, Grady Memorial Health System
I am a PGY-1 Pharmacy resident at Grady Memorial Hospital. I graduated from the University of Georgia with my bachelors and my PharmD. My interests include infectious diseases and critical care.
Evaluators
HB
Thursday April 24, 2025 12:00pm - 12:15pm EDT
Parthenon 1
  Internal Medicine (IM), Grady Memorial Hospital
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