Salem Veterans Affairs Medical Center-Salem, VA.

I am currently doing an Ambulatory Care rotation in the Anticoagulation Clinic at the Salem Veterans Affairs Medical Center in Salem, VA. We deal primarily with monitoring anticoagulation for patients with deep vein thromboembolism (DVT), pulmonary embolism (PE), and atrial fibrillation. This clinic focuses on medication adherence, patient counseling and in-depth warfarin management. Patients are called on a weekly, monthly, biannual and annual basis depending on their medication and lab results. After their labs result, I analyze their chemistry profile, CBC and coagulation results and make adjustments to their medication dosages. Throughout this rotation, I have counseled numerous patients on the importance of medication adherence, diet and lifestyle changes, and reducing the risk of clots in the body. I have made medication adjustments based on patient adherence, diet changes and various drug-drug interactions (especially with warfarin). We also conducted multiple topic discussions regarding guideline updates and periprocedural guidelines with my preceptor, other pharmacists and residents. Lastly, I was given the opportunity to work on a Medication Use Evaluation (MUE) research project and to write a case report regarding a patient who experienced angioedema while taking both a Factor Xa inhibitor and Pradaxa; both of which will soon be published. My advice is to review all anticoagulation medications, contraindications and dosage adjustments. Although this clinic primarily focused on oral anticoagulants, it would be beneficial to understand the importance of injectable anticoagulants as well. Also, make sure to prepare yourself ahead of time for the questions you may have to answer and patient counseling points you may have to provide. Study smart and GOOD LUCK!