Referral Criteria

REFERRAL CRITERIA: (Form)

Referrals are seen by appointment at all sites
Service days are Monday through Friday, excepting Statutory holidays

Criteria for Patient Eligibility to the Anticoagulation Management Service (AMS)

Patients will be eligible for the Calgary Health Region AMS provided they meet all of the following criteria:

Live within the Calgary Health Region.
- Patients residing outside the Calgary Health Region, but remaining in the region post-hospital discharge for > 3 days are eligible for management by the clinics
- Patients residing outside the Calgary Health Region will be transferred to their local family physician at the earliest opportunity

Willing to be active participant in their care (see AMS Patient Responsibilities)

Patient or caregiver demonstrates the capacity to understand the condition and implications of anticoagulant therapy

Patients will NOT be eligible for admission to the Calgary Health Region AMS in the following circumstances:

Patients requiring anticoagulants for prophylaxis (excludes prophylaxis in pregnancy or post-partum)

Patients residing in extended care facilities with an approved long term care anticoagulation management algorithm; these patients will be managed by the long term care facility.

Inpatients continuing on anticoagulation therapy which they received prior to hospital admission; these patients are to be referred back to their family physician for anticoagulation management at hospital discharge unless high risk (see definition below).

Patients receiving hemodialysis are managed by nephrology, due to frequent vascular interventions, and frequent anticoagulant adjustments related to dialysis runs/timing.

Criteria for AMS referral from the Community

U/S confirmed DVT in community, PE should initially be managed in hospital
Peri-procedural – if patient not assessed at Pre-op Assessment Clinic
- Patients referred to the clinic for peri-procedural ‘bridging’ will be transferred back to their family physician as soon as the INR has returned to the target range post-operatively.
Patients at high risk due to:
- Significant comorbidity
- Multiple interacting drugs
- Adherence issues
- Prior bleeding or thromboembolic complications
Patients who have experienced an adverse bleeding/clotting event but still require anticoagulation with monitoring of 3-7 days.

Patients on/treated with LMWH only will be managed by the clinic for the initial 4 weeks of therapy then transferred back for further follow-up by the family physician.

Pregnant patients on therapeutic LMWH will be monitored for the duration of therapy for anti-Xa monitoring and switch to unfractionated heparin.