Impact of a Pharmacist‐Led Warfarin Self‐Management Program on Quality of Life and Anticoagulation Control: A Randomized Trial

Abstract

A self-management warfarin program led by pharmacists resulted in significant improvement in the quality of life of patients receiving warfarin therapy as well as a reduction in the time required for anticoagulation monitoring, while maintaining a level of anticoagulation control similar to a high-quality specialized anticoagulation clinic.

The clinical effectiveness and cost-effectiveness of point-of-care tests (CoaguChek system, INRatio2 PT/INR monitor and ProTime Microcoagulation system) for the self-monitoring of the coagulation status of people receiving long-term vitamin K antagonist therapy, compared with standard UK practice: systematic review and economic evaluation

“…55,57,[61][62][63][64][65] In 11 trials, the randomisation process proved to be adequate but no information was provided on the way in which participants were allocated to the study interventions. 58,60,[66][67][68][69][70][71][72][73][74] One trial 75 reported adequate details about the generation of the random sequence but failed to conceal the allocation of participants to study interventions. In contrast, another trial 76 reported adequate information on allocation concealment but failed to provide details on the randomisation process.…”

“…Six of them had limited missing data with similar reasons for discontinuation across intervention groups. 59,69,72,74,76,79 Seven trials relied on an intention-to-treat approach and all dropouts were fully accounted for in the statistical analyses, 55,61,[63][64][65]71,75 while the other four reported no missing data. 58,60,62,78 Eight of the 26 included trials were at high risk of attrition bias, with more than 5% dropout rate and with missing data not appropriately tackled.…”

“…55,58,[61][62][63]72,77 In six trials, neither the participants nor the personnel involved in delivering the interventions were blinded. 60,65,66,71,74,75 One trial 70 was described as 'double blinded' but no further information was given. Another trial 68 reported that one of the two standard care groups studied (the untrained routine group) was blinded.…”

“…61 Three trials were conducted in Canada 55, 65,74 and one in the USA. 71 Of the 26 included trials, seven were multicentred, 60,63,64,67,68,71,72 while the remaining 19 were conducted in a single centre.…”

“…55 Warfarin was the choice of vitamin K antagonist therapy in half of the included trials. 45,55,56,58,62,[64][65][66][67]69,71,73,74,78 In seven trials, participants were taking phenprocoumon and/or acenocoumarol and/or fluindione 57, 61,63,68,72,76,77 and, in one trial, participants received either warfarin or phenprocoumon. 75 In the remaining four trials, the type of vitamin K antagonist therapy was not reported.…”