Optimizing warfarin and dual oral anticoagulation practices in an academic clinic during a merger amid the COVID-19 pandemic in a marginalized population.

This article focuses on a quality control project aimed at improving warfarin management during the COVID-19 pandemic following the closure of a pharmacy-led anticoagulation clinic and its transition to an academic physician-led clinic without point-of-care (POC) international normalized ratio (INR) testing. The multidisciplinary team implemented seven interventions—including patient and provider education, standardized workflows, enhanced patient outreach, and transitioning eligible patients to dual oral anticoagulants (DOACs)—to increase the percentage of patients within the optimal time in therapeutic range (TTR) and improve safety outcomes. Over 24 months, the project achieved sustained improvements in TTR rates, increased INR completion from 63% to 92%, and successfully transitioned over 50% of eligible patients to DOACs, with no bleeding episodes reported in the post-project period. The study highlights the feasibility of optimizing anticoagulation management in resource-limited, diverse primary care settings without POC INR testing, emphasizing the importance of multidisciplinary collaboration, patient engagement, and structured protocols. Future directions include integrating digital health technologies and culturally tailored resources to further enhance care coordination and address health equity.