Anticoagulation control of pharmacistmanaged coll

Authors: Surasak Saokaew Ubonwan Sapoo Surakit Nathisuwan Nathorn Chaiyakunapruk Unchalee Permsuwan

Publish Date: 2011/12/28

Volume: 34, Issue: 1, Pages: 105-112

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Abstract

Objective There has been a lack of evidence of the effects of pharmacistmanaged warfarin therapy PMWT in developing countries eg Southeast Asian countries where the patients’ characteristics genetic makeup clinical practice and healthcare system are different from the Western world This study aimed to compare the anticoagulation control and clinical outcomes associated with warfarin therapy provided by PMWT to usual care UC in the Thai population Setting A 1000bed tertiarycare hospital in Nakornratchasima province of Thailand Method A quasiexperimental study comparing PMWT and UC in patients receiving longterm warfarin therapy For PMWT group clinical pharmacists optimised the warfarin therapy and suggested recommendations eg dose adjustment safer alternative drugs and followup time to physicians The UC group received the standard care Main outcome measure Time in therapeutic range TTR both actual and expandedTTR bleeding and thromboembolic complications and physician’ acceptance of pharmacist suggestions Results Of 433 patients enrolled 220 and 213 were in the PMWT and UC groups respectively At baseline patient’s characteristics of both groups were comparable At the end of followup period patients in the PMWT group had significantly higher actualTTR 483 vs 401 P  0001 and expandedTTR 627 vs 539 P  0001 compared to those in the UC group Rates of major bleeding were 44 vs 45 events per 100 personyears for the PMWT and UC groups respectively Pharmacists performed 284 interventions with an acceptance rate of 803 from physicians Conclusion Pharmacistmanaged warfarin therapy resulted in a significantly better anticoagulation control This study showed that a collaborative approach in anticoagulation management can be successfully implemented in a developing country Implementation of such care model in other developing countries should be consideredWe would like to acknowledge and thank the Maharat Nakornratchasima Hospital for granting permission to use data provided in this study and Prof Dr Jayanton Patumanond for statistics suggestion We gratefully acknowledge Dr Bancha Sookananchai Dr Damri Sethachinda Dr Tongprakob Siriwanij Mrs Amonrat Pangthaisong CCTS staffs and all pharmacists for their significant contribution for this project

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