Clinical outcomes of a pharmacist-managed anticoagulation service for breast cancer patients

Jones, Kyle M.; Barnett, Chad M.; Gauthier, Michelle; Boster, Bonnie L; Espirito, Janet L.; Michaud, Laura Boehnke

doi:10.1177/1078155210397775

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…(1.6% versus 9.1% of the prescriptions). 28 Higher rates of potential DDI (27–58%) have been reported in more specific studies including ambulatory patients under intravenous anticancer treatment. 29,30 In all, our lower rate of DDI may be explained by the fact that we intervene on major issues, using a different screening method, in the context of an inpatient setting that allows enhanced and continuous monitoring.…”

Section: Discussionmentioning

confidence: 94%

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Impact of clinical pharmacy services in a hematology/oncology ward in Morocco

Moukafih¹,

Abahssain²,

Mrabti³

et al. 2020

J Oncol Pharm Pract

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Background Clinical pharmacists are contributing to safe medication use by providing comprehensive management to patients and medical staff. The aim of this study is to document and evaluate the role of clinical pharmacy services in oncology department. Patients and methods A prospective, descriptive, observational study was carried out from July 2018 through June 2019 at the Department of Medical Oncology at the National Institute of Oncology, Morocco. Medication reviews concerning hospitalized adult cancer patients were performed every day by the clinical pharmacist assigned to the department. Results A total of 3542 prescriptions of 526 adult cancer patients were analyzed. The pharmacist identified 450 drug-related problems (12.7% of the prescriptions) primarily related to the analgesics (31.5%). Medication problems included mostly untreated indications (31.3%), overdosing (17.1%), drug–drug interactions (12.4%), underdosing (11.1%), administration omissions (6.7%), drug not indicated (6.0%), and contraindication (5.3%). Interventions ( n = 450) led to drug additions (30.7%), drug dosing adjustments (27.1%), treatment discontinuations (20.0%), recall of the treatment (6.2%), replacement of a drug with another one (5.1%), administration optimization (4.0%), therapeutic drug monitoring (3.1%), alternate routes of administration (2.5%), and extension of treatment duration (1.3%). Most (98%) of the interventions were accepted and implemented by the medical staff—172 (38.2%) having a significant clinical impact on the patient, 88 (19.6%) as having a very significant clinical impact, and 71(15.8%) as having a potential vital impact. Conclusion This work highlights the positive clinical relevance of pharmacists’ interventions in oncology and the importance of medicopharmaceutical collaboration to prevent medication error.

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Section: Discussionmentioning

confidence: 94%

“…DRP mainly concerned contraindications (46.9%) and DDI (44.4%). 28 Discrepancies may be applicable to differences in the classification of medical problems and the type of population (outpatient versus inpatient setting). Regarding DDI, we report a lower rate than Bulsink et al.…”

Section: Discussionmentioning

confidence: 99%

Impact of clinical pharmacy services in a hematology/oncology ward in Morocco

Moukafih¹,

Abahssain²,

Mrabti³

et al. 2020

J Oncol Pharm Pract

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“…Our results are similar to a retrospective study in which the rate of recurrent VTE in 145 patients with breast cancer managed by a dedicated AMS was 4.1% with an average TTR of 53%. 19 Warfarin management in patients with cancer is challenging and requires more frequent INR monitoring than in other patient populations, such as those with atrial fibrillation. Drug–drug interactions occur frequently with many chemotherapy regimens, 20 but careful monitoring and dose adjustment by dedicated staff can mitigate significant variations in INR results, as evidenced by our center TTR of 59.5%.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Recurrence of Venous Thromboembolism in Patients With Cancer Treated With Warfarin

Marshall

Campigotto

Neuberg

et al. 2015

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is a common complication in patients with cancer. Previous randomized studies have demonstrated that rates of recurrent VTE are lower in patients treated with low-molecular-weight heparin compared to warfarin. We performed a retrospective analysis of 236 patients with cancer managed by a dedicated oncology anticoagulation management service to compare “real-world” rates of recurrent VTE and bleeding in patients treated with warfarin versus parenteral anticoagulants. Initial anticoagulant regimen included a parenteral agent with transition to warfarin in 132 (55.9%) patients, enoxaparin in 53 (22.5%), dalteparin in 37 (15.7%), and fondaparinux in 14 (5.9%). Taking into account the competing risk of death, cumulative incidence of VTE recurrence at 6 months was 4.0% with warfarin, 10.3% with enoxaparin, 3.0% with dalteparin, and 7.7% with fondaparinux (P = .004). Bleeding complications occurred in 10.6% of patients on warfarin, 17.0% on enoxaprin, 27.0% on dalteparin, and 14.3% on fondaparinux (P = .089). In a dedicated anticoagulation clinic, specific for patients with cancer, warfarin may be an acceptable treatment for first thrombotic events in patients with cancer.

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“…13 An explanation for the hindered pharmacist authority to perform progressive patient care functions stems from a current lack of fully qualified professionals. A majority of comprehensive cancer centers do not have a credentialing and privileging program defining pharmacists' prescribing rights and scope of practice.…”

Section: No (%) Respondents (N = 26)mentioning

confidence: 99%