• Outpatients receiving oral anticoagulant therapy

• Patients taking antithrombotic agents who are scheduled for an invasive procedure

Since 2012, our hospital has established a pharmacist-led anticoagulation clinic to participate in interdisciplinary care and enhance the efficacy and safety of anticoagulant therapy. In 2017, we further developed the “Intelligent Anticoagulation Clinic Service System,” which has effectively strengthened the quality of outpatient care. Owing to its high promotional value, the system was successfully transferred as a technology licensing project in January 2022, followed by completion of a commercialized version. In addition, to ensure that every patient taking antithrombotic agents receives appropriate medication interruption assessment and care before undergoing invasive examinations or procedures, the Department of Pharmacy led the optimization of the antithrombotic medication alert functions. By pioneering the use of evidence-based medicine to provide intelligent medication-interruption decision support, the project received the Gold Award in the Evidence-Based Healthcare Application category of the 2020 National Healthcare Quality Awards. To further enhance the quality of medication-interruption assessment across the hospital, we are continuing to develop the “Smart Decision Support System for Safe Management of Antithrombotic Therapy,” which aims to provide systematic and intelligent assistance for evaluating medication interruption and resumption before and after invasive procedures, thereby ensuring both the efficacy and safety of patient therapy.

Intelligent Anticoagulation Clinic Service System: Automatically integrates medical records, provides intelligent decision support, enhances communication between healthcare providers and patients, supports telehealth services and case management, and incorporates quantitative indicators for quality monitoring. Its innovative functions have been granted a domestic utility model patent. 2. Antithrombotic Medication Alert and Decision Support System: Proactively checks in-hospital and cloud-based medication records, provides evidence-based recommendations for medication interruption, and generates visualized instruction sheets. The upgraded version will incorporate bleeding-risk assessment and patient-specific data to enhance precision, and will integrate with care pathways. This system has also been granted a domestic utility model patent.

• The pharmacist-led anticoagulation clinic has provided care to more than 3,000 patient visits to date.

• The antithrombotic medication alert system detects an average of 970 hospitalized patients using antithrombotic agents each month.

• The pharmacist-led anticoagulation clinic achieved a 100% completeness rate in both service delivery and documentation.

• More than 50% of medication-related issues were fully resolved through pharmacist interventions in the clinic.

• Following pharmacist intervention, the warfarin time in therapeutic range (TTR) improved to 74.6% (P = 0.006).

• The system conducts comprehensive screening and provides alerts for antithrombotic agents across all outpatient pre-admission inputs and surgical scheduling, achieving a 100% implementation rate.

• Pharmacists in the anticoagulation clinic provided medication-interruption recommendations, with no patients experiencing thromboembolic or major bleeding events.

• Following the implementation of the alert system, the annual number of strokes caused by improper preoperative medication discontinuation dropped from 8 to zero.

• After the alert system was deployed, the annual incidence of surgery delays due to inappropriate preoperative medication interruption decreased from 18 to zero.

• All pharmacists (100%) acknowledged that the anticoagulation clinic system supports familiarity with the service workflow.

• The medication-interruption alert system received a high satisfaction rate of 88% from healthcare staff.

• Patients expressed a 96% satisfaction rate with the instruction sheets for medication interruption.

• PLoS One 2022; 17: e0270263

• Presented at the AMEE Lyon 2022 Hybrid Conference

• Delivered more than 28 invited talks at international and national events

• Received and hosted over 10 international and domestic delegations

• Enhance the quality of anticoagulation pharmaceutical care

• Prevent bleeding or thromboembolic events caused by inappropriate interruption of antithrombotic therapy