Clinical impact of a pharmacist-led inpatient anticoagulation service: a review of the literature

Lee, Tiffany; Davis, Erin; Kielly, Jason

doi:10.2147/iprp.s93312

Cited by 29 publications

(25 citation statements)

References 27 publications

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“…13,14 Also, pharmacist recommendations diminished the number of medication errors, drug interactions, and INR reading outrange, which in turn lead to higher TTR values and greater patients medication adherence. 18 A study by Aidit et al indicated that pharmacists had a positive influence on management by implementing warfarin medication-adherence clinics ith pharmacists who dedicated some of their time to education, counseling, and dealing with adherence issues. 19 Furthermore, pharmacists' accessibility for questions and communication influenced the excellent management of anticoagulation that facilitated the establishment of a community pharmacist-led anticoagulation-management service in New Zealand and the development of pharmacist community clinics for anticoagulation in some parts of the US and UK.…”

Section: Discussionmentioning

confidence: 99%

<p>Anticoagulation Control of Warfarin in Pharmacist-Led Clinics Versus Physician-Led Clinics: A Prospective Observational Study</p>

Alghadeeer¹,

AlZahrani²,

Alalayet³

et al. 2020

RMHP

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Purpose: Warfarin is an affordable drug used for numerous indications, and still a favorable choice for patients with a history of bleeding from direct oral anticoagulants or presence of valvular heart diseases. However, warfarin requires regular international normalized ratio (INR) monitoring for safety and efficacy. Warfarin's efficacy and safety is correlated with actual time spent within the therapeutic INR. Time in therapeutic range (TTR) is an estimate that measures the percentage of actual time spent within the therapeutic INR. Our aim was to investigate differences in anticoagulation control of warfarin using TTR between pharmacists and other health-care providers. Methods: This prospective observational study was conducted in an ambulatory-care setting of a tertiary hospital to compare anticoagulation management using TTR between clinics run by pharmacists versus other health-care providers. Results: A total of 62 patients were enrolled: 33 in the pharmacist-led clinic and 29 in the physician-led clinic. TTR levels were statistically higher among patients in the pharmacistled clinic than than the physician-led clinic (87.27%±3.82% and 52.48%±5.49%, respectively; p<0.001). For 27 patients followed retrospectively by physicians and prospectively by clinical pharmacists, TTR was statistically higher during clinical pharmacists' care (91.70% ±2.93% versus 61.39%±5.11%, respectively; p<0.001). During the study, approximately 82% of patients reached their target INR in the pharmacist-led clinic compared to 24% in the physician-led clinic. Conclusion: The findings of our study found that patients followed in the pharmacist-led clinic had higher TTR levels than those followed in the physician-led clinic.

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Section: Discussionmentioning

confidence: 99%

<p>Anticoagulation Control of Warfarin in Pharmacist-Led Clinics Versus Physician-Led Clinics: A Prospective Observational Study</p>

Alghadeeer¹,

AlZahrani²,

Alalayet³

et al. 2020

RMHP

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“…The PMWP resulted in improved INR for inpatient warfarin recipients and to less near-term bleeding among higher risk, surgical patients. 7 Pharmacist consultation and management of patients on warfarin therapy has shown to improve INR and reduce adverse events compared to physician-managed groups.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a pharmacist-managed warfarin dosing service in a community hospital

Samuel¹,

Thomas²,

Shah³

et al. 2021

PPIJ

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Objective: Warfarin is used as the mainstay of oral anticoagulant therapy for the prevention and treatment of various thromboembolic disorders. Effective methods of managing anticoagulation are available, but underemployed. Standardized dosing protocols (nomograms) and anticoagulation management services are some ways to manage warfarin use. The primary objective of this study was to evaluate a difference in time in therapeutic range (TTR) of international normalized ratio (INR) level in physician-managed groups versus pharmacist-managed warfarin groups. Methods:The institutional review board approved this single center, retrospective study which was conducted in a small community hospital. Men and women ages 44-97 who were previously on or began warfarin therapy during hospitalization were evaluated for selection. A total of 38 patients were randomly selected for the review during August-December 2017. The primary outcome of TTR in physician-versus pharmacist-managed warfarin groups was calculated. A two proportion Z-test was utilized for statistical analysis. Secondary outcomes included time with subtherapeutic INR, time with supratherapeutic INR, safety outcomes (bleeding, transfusion), and the need for bridge therapy.Results: Thirty-four total patients were included for the final review, and four were excluded as they switched from one group to another during the review period. The primary outcome, TTR, was higher in the pharmacist-managed group compared to the physician-managed group (p=0.03). Secondary outcomes were similar in both groups per descriptive statistics. Conclusions:Pharmacist consults for warfarin management or auto consults for all orders should be considered more often. The clinical significance of TTR when warfarin is managed by pharmacists must be determined in larger, randomized clinical trials.

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“…The involvement of pharmacist has also caused significant reduction in ADRs associated with anticoagulants. 14…”

Section: Anticoagulation Clinicsmentioning

confidence: 99%

Revolutionary Role of Clinical Pharmacist in Specialised Clinics: Professional Approach for Better Patient Care

James¹,

Joseph²,

Ps³

et al. 2020

IJOPP

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The treatment associated economic burden of our country is rising at an alarming rate due to the prevalence of various disease conditions. Since the burden of disease and its management cost is increasing, India has got all reasons to be alarmed over matters of health. Without finding out and implementing newer alternatives to meet the health needs of the population, the present health system has to do more to come up with the struggles in order to provide the adequate healthcare services to get the desired outcome. Focussed or personalised care can be foreseen as a remedy and has been considered as a core component in achieving a sustained high quality health outcome. Specialised clinics devoted to an area of speciality aims at providing focussed or personalised care to the patient which enables to provide more medical attention to the patient by the involvement of multidisciplinary health professionals and is also cost effective. The specialised clinics plays a major role in timely follow ups to ensure that the patient gets the individualised optimal therapy.

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Clinical impact of a pharmacist-led inpatient anticoagulation service: a review of the literature

Cited by 29 publications

References 27 publications

<p>Anticoagulation Control of Warfarin in Pharmacist-Led Clinics Versus Physician-Led Clinics: A Prospective Observational Study</p>

<p>Anticoagulation Control of Warfarin in Pharmacist-Led Clinics Versus Physician-Led Clinics: A Prospective Observational Study</p>

Evaluation of a pharmacist-managed warfarin dosing service in a community hospital

Revolutionary Role of Clinical Pharmacist in Specialised Clinics: Professional Approach for Better Patient Care

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