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The MelroseWakefield Hospital Anticoagulation Management Service (AMS) is an outpatient ambulatory care clinic for patients on anticoagulants located at 15 Green St. in Melrose, MA. The Clinical Pharmacy Specialist- Anticoagulation Management Service will focus on the management of patients taking warfarin and direct oral anticoagulants (rivaroxaban, apixaban, and dabigatran). The clinical pharmacy specialist will be responsible for ensuring appropriate dosing and monitoring of these medications, patient education, and perioperative management. In addition, the clinical pharmacy specialist will be involved in the pharmosurveillence of inpatients on anticoagulant medications and make appropriate interventions to providers when necessary. Common disease states that may be encountered include but are not limited to: Atrial fibrillation/flutter, Valvular heart disease, DVT/PE prophylaxis and treatment, thrombophilic disorders such as Factor V Leiden, Antiphospholipid antibody, Prothrombin 20210A, Antithrombin III deficiency, and Protein C & S deficiency.