2026 Eastern States Conference

Title: Determining direct oral anticoagulant eligibility among warfarin-treated inpatients: a retrospective chart review 
Authors: Ciara Marro-Wilson, PharmD; Samantha Paone, PharmD, MBA, BCPS; Preethi Samuel, PharmD, BCACP, AAHIVP; Jennifer Premus, PharmD
Objective: At the conclusion of my presentation, the participant will be able to differentiate between eligible patients and those who are ineligible for conversion from warfarin to a direct oral anticoagulant (DOAC) based on patient-specific factors and clinical characteristics.
Self Assessment Question: Which of the following patients would be eligible for a DOAC?
A. A patient with triple antiphospholipid syndrome
B. A patient with non-valvular atrial fibrillation
C. A patient with moderate-to-severe rheumatic mitral stenosis
D. A patient with a mechanical mitral valve
Background: To evaluate whether patients admitted on warfarin were eligible for transition to a DOAC and, for those ineligible, identify and categorize by reason for ineligibility.
Methods: This retrospective chart review assessed patients 18 years and older on warfarin admitted to Staten Island University Hospital North and Princes Bay between December 31st, 2024 and December 31st, 2025 with pregnancy and/or breastfeeding as the sole exclusion criteria. For patients who met the pre-specified criteria, anticoagulation indication was documented along with pertinent clinical factors such as HAS-BLED and CHA2DS2-VASc scores for those with atrial fibrillation, Child-Pugh classification for hepatic dysfunction, eGFR, duration of warfarin use, total weekly warfarin dose, INR goal, previous DOAC use, history of bleeding and/or thrombosis while on warfarin, current DAPT, and relevant drug-drug interactions. Descriptive statistics were utilized to determine the proportion of patients who were appropriate candidates for a DOAC during admission and to identify, as well as quantify, specific factors that deemed patients ineligible.
Results: A total of 229 charts were reviewed. Overall, 44.5% of patients were deemed eligible for conversion to a DOAC during the reviewed admissions. Among ineligible patients, the most common reasons for ineligibility were presence of a mechanical heart valve (44.1%), valvular atrial fibrillation (33.1%), and antiphospholipid syndrome (29.1%). Additional reasons included a thromboembolic event while on a DOAC (15.7%), a transcatheter aortic valve replacement (5.5%), thrombophilia (6.3%), moderate-to-severe mitral stenosis (5.5%), Child-Pugh Class C (3.1%), and unclear valvular involvement or embolic stroke of undetermined source (0.8%). Patients could have more than one reason for ineligibility.
Conclusion: Several patients remained eligible for a DOAC, revealing missed opportunities for consideration of safer, less pharmacokinetic-reliant anticoagulation options. Overall, these findings may suggest that structured, real-time inpatient review may improve DOAC candidate identification and foster provider collaboration to provide patients with proven, safer alternatives.