A Trial of Pharmacist Management of Oral Anticoagulation THerapy in the communitY for AF

Prior treatment

• AF on optimal OAC therapy
• OAC required for other conditions (i.e. DVT/PE, PCI in prior year, left ventricular thrombus, etc.)
• Currently taking two antiplatelet agents
• Major surgery in prior month (defined as surgery requiring general anesthesia and overnight inpatient hospital stay)

Other illness

• Uncontrolled hypertension (defined as SBP ≥160 mmHg x 2 BP readings measured at screening)
• End-stage renal disease (CrCl \<15 ml/min or dialysis)
• Severe cognitive impairment (≥5 errors on the Short Portable Mental Status Questionnaire)

Lab values

• History of "major bleeding" in prior year (defined as overt bleeding at critical site including intracranial, intraspinal, intraocular, pericardial, GI bleed, bleed requiring hospitalization, bleed resulting in ≥20 g/L drop in hemoglobin or requiring transfusion of ≥2 units packed cells)

Other

• Excess alcohol intake (≥8 alcoholic drinks/week)
• Inability to read or understand English or Spanish
• Participants considered unreliable by the Investigator or designated pharmacy team member concerning the requirements of follow-up, or those with foreshortened life expectancy precluding 3-month follow-up
• Pregnant women

• Age \> 60 years
• Men (CHADS-VASc score ≥2) AND Women (CHADS-VASc score ≥3)
• AF and not on OAC therapy but eligible
• AF and on sub-optimal or inappropriate OAC therapy
• Written informed consent