Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration

Wong, Yee M.; Quek, Y.-N.; Tay, Jam Chin; Chadachan, Veerendra; Lee, H. K.

doi:10.1111/j.1365-2710.2010.01216.x

Cited by 41 publications

(41 citation statements)

References 11 publications

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“…[3][4][5][6] In contrast to warfarin, dabigatran does not require routine laboratory monitoring and is marketed as being less burdensome for patients; however, the lack of regular monitoring may be a limitation. Absence of regular contact with health care providers who monitor adherence and other issues may increase the likelihood of transiently missing or skipping anticoagulant doses, thereby increasing the risk of a thromboembolic event.…”

Section: Outcomementioning

confidence: 99%

A Retrospective Descriptive Analysis of Patient Adherence to Dabigatran at a Large Academic Medical Center

Cutler¹,

Chuang²,

Huynh³

et al. 2014

JMCP

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BACKGROUND: Clinical trials evaluating the efficacy of dabigatran followed a very strict protocol, which included close monitoring and follow-up. Patients followed in this controlled environment had an average medication possession ratio (MPR) > 0.95. However, very few studies have evaluated patient adherence to dabigatran in a real-world setting. Other studies of chronic medications indicate patients are not reliably adherent to twice daily regimens. Adherence to therapy is particularly important for direct thrombin inhibitors because there may be a risk of increased thromboembolic events associated with poor adherence to these agents.

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Section: Outcomementioning

confidence: 99%

A Retrospective Descriptive Analysis of Patient Adherence to Dabigatran at a Large Academic Medical Center

Cutler¹,

Chuang²,

Huynh³

et al. 2014

JMCP

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“…Having pharmacists monitor these patients throughout therapy and until completion of treatment allows for interventions to be made when issues arise. [12][13][14][15] Due to the complexity involved in managing therapy, the Joint Commission (TJC) has challenged hospitals to reduce the likelihood of patient harm associated with the use of anticoagulant therapy through the National Patient Safety goals. Presently, our institution has made great strides to attain these goals but ongoing effort is essential to maintain and exceed the expectations put forth by TJC.…”

Section: Introductionmentioning

confidence: 99%

Development of an Anticoagulation Stewardship Program at a Large Tertiary Care Academic Institution

Padrón

Miyares

2013

Journal of Pharmacy Practice

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Pharmacist-directed anticoagulation management services (AMSs) have been shown to significantly lower anticoagulation-related mortality, length of hospital stay, bleeding complications, blood transfusion requirements, and cost of therapy. AMSs are only 1 component of an anticoagulation stewardship program. Frequently, stewardship programs are limited to inpatient populations. Incorporating components that facilitate transition to outpatient status will ideally encompass complete care. The purpose of this program was to expand anticoagulation services and standardize care by implementing a full-service stewardship program including a transition of care service. The first component of the study involved medication surveillance for inpatients on anticoagulation therapy. The second component involved transitioning patients on anticoagulation, primarily with venous thromboembolism (VTE) to outpatient management. Finally, the pharmacist identified areas for optimization. Optimization involved developing or updating protocols to reflect updates in the literature as well as updating institution-specific information resources. Interventions made through medication surveillance and utilization of the VTE transition of care services translated into a total cost savings of approximately US$270 320. A postgraduate, first-year pharmacy resident contributed to improving patient outcomes while reducing utilization of hospital services and obtaining substantial cost savings through participation in anticoagulation stewardship services.

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“…11 Additionally, pharmacist guidance with warfarin administration has shown greater achievement of therapeutic INR. [12][13][14][15] Combined with findings from our survey, this suggests that pharmacists can play an important role in ensuring proper management of vitamin K therapy.…”

Section: Discussionmentioning

confidence: 86%

Risk Factors for Bleeding in Hospitalized Patients with Elevated INR: No Vitamin K Therapy Received versus Vitamin K Received

et al. 2015

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Background: Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored. Methods: A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K. Records from adult inpatients with at least one INR value between 4.5 and 9 were reviewed. A total of 51 records were evaluated. Thirty-four patients did not receive vitamin K compared to 17 who did. Bleeding events, readmissions rates, length of stay, and familiarity with new guidelines were studied. Results: Mean age of patients was 73 years, and 71% were female. No statistically significant differences were observed in bleeding events between patients who received vitamin K and those who did not: 2/17 (12%) and 1/34 (3%), respectively (P = .30). No differences in 30-day readmission rates (24% vs 18%; P = .71) or in length of stay (7 vs 4 days; P = .11) were found. All pharmacists (13 of 13) were familiar with CHEST 2012 guidelines on the management of supratherapeutic INR compared to 10 of 21 (48%) hospitalists (P = .001). Conclusions: With the national focus on reduction of health care costs, health systems are looking at innovative ways to reduce readmission rates and length of stay. This study, which evaluated the use of vitamin K administration, showed no statistical difference between bleeding events, readmission rates, and length of stay in patients who received vitamin K. Education on the updates of guidelines may be beneficial, as many providers were not familiar with the changes in recommendations.

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Efficacy and safety of a pharmacist-managed inpatient anticoagulation service for warfarin initiation and titration

Abstract: Inpatient anticoagulation care and outcomes were significantly improved by a pharmacist-managed anticoagulation service. The time to therapeutic INR was achieved appropriately and efficiently without compromising patient's safety.

Cited by 41 publications

References 11 publications

A Retrospective Descriptive Analysis of Patient Adherence to Dabigatran at a Large Academic Medical Center

A Retrospective Descriptive Analysis of Patient Adherence to Dabigatran at a Large Academic Medical Center

Development of an Anticoagulation Stewardship Program at a Large Tertiary Care Academic Institution

Risk Factors for Bleeding in Hospitalized Patients with Elevated INR: No Vitamin K Therapy Received versus Vitamin K Received

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