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  1. Carver, Heather R. DNP, RN, FNP-BC
  2. Studeny, Mark MD, FACC
  3. Gress, Todd W. MD, MPH
  4. Wood, Kathryn A. PhD, RN


We sought to improve patient outcomes and efficiency in our anticoagulation clinic through development of a new protocol for managing heart valve patients with subtherapeutic international normalized ratio (INR) tests. The new protocol standardized use of 1 anticoagulation agent while warfarin was retitrated, timelines for INR retesting, and target INR levels depending on the type of valve implanted. The new protocol provided significant improvements in patient care; however, outcomes for clinic operating efficiency were mixed.