As warfarin therapy requires close monitoring, Munson Healthcare’s two anticoagulation clinics support patients with minimally invasive testing to ensure their blood is clotting appropriately and provide follow-up care. By offering these clinics, patients can conveniently have their blood monitored close to home. Staffed by specially trained pharmacists, our clinics work closely with primary care providers on medication management. Test results and dosage recommendations are shared with primary care providers, ensuring continuity of care.
Services Provided
- Anticoagulation Management:
- Fingerstick international normalized ratio (INR) tests are performed on-site in our clinics, removing the need for a venipuncture (unless the INR is critical, i.e., ≥6).
- Based on patient’s result and answers to specific questions, warfarin dosage is adjusted as needed.
- Patient’s medication list (including non-prescription products, herbals, and nutritional supplements) are reviewed for duplicate therapies and potential drug interactions. If needed, we will contact the primary care provider’s office for clarification.
- Patients leave with INR, dosage instructions, and appointment schedule.
- If indicated, we’ll call in a new warfarin prescription to the pharmacy of their choice.
- Perioperative Anticoagulation Management:
- We’re available to support patients when a procedure/surgery requires warfarin be stopped beforehand.
- Using clinical guidance learned from the Bridge Trial,1 we can determine whether the patient needs to be bridged before and after the procedure with Lovenox (enoxaparin). If indicated, we will calculate their ideal dosage, create a patient-specific instruction sheet, and manage their peri-operative anticoagulation, along with ordering the Lovenox and instructing them on how to administer.
Note: Randomized controlled trials suggest direct oral anticoagulant (DOAC) may not be as effective or as safe as warfarin treatment in those who have mechanical heart valves, thrombotic antiphospholipid syndrome, atrial fibrillation associated w/rheumatic heart disease, and embolic stroke of undetermined origin. DOAC efficacy is uncertain for conditions such as left ventricular thrombus, catheter-associated DVT, cerebral venous sinus thrombosis, and for patients with afib or venous thrombosis who have end-stage renal disease.2
Locations
Manistee
Manistee Community Health Center | 1345 E. Parkdale Ave., Manistee
Phone 231-398-1756 | Fax 231-398-1327
Traverse City
Foster Family Community Health Center | 550 Munson Ave., Traverse City
Phone 231-935-9341 | Fax 231-935-9342
How to Refer
A provider referral is required. To refer your patients who are on blood thinners, call or fax their information. We will enroll referrals and begin our services promptly.
Although this service is covered by most insurances, patients are encouraged to check with their health insurance provider to understand covered benefits.
1Douketis J et al. Perioperative Bridging Anticoagulation Patients with Atrial Fibrillation. N Engl J Med. 2015; 373:823-833.
2Bejjani A et al. When Direct Oral Anticoagulants Should Not Be Standard Treatment. J Am Coll Cardiol 2024;83:444-465.