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Inpatient warfarin management: pharmacist management using a detailed dosing protocol
Nancy L Dawson1, Ivan E Porter, Dusko Klipa
1Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA. dawson.nancy11@mayo.edu
Journal of Thrombosis and Thrombolysis
|November 15, 2011
Summary
A new warfarin dosing protocol managed by pharmacists significantly reduced excessive anticoagulation (INR > 5) in hospitalized patients. This pharmacist-led approach improved therapeutic international normalized ratio (INR) control with minimal physician intervention.
Area of Science:
- Pharmacology
- Internal Medicine
- Clinical Pharmacy
Background:
- Hospitalized patients on warfarin face risks due to challenges in maintaining therapeutic international normalized ratio (INR).
- Supratherapeutic INR levels can lead to adverse events in patients receiving anticoagulant therapy.
Purpose of the Study:
- To evaluate if a detailed warfarin dosing protocol, managed by pharmacists with limited physician oversight, reduces supratherapeutic INR in hospitalized patients.
- To assess the impact of pharmacist-led warfarin management on achieving and maintaining therapeutic INR levels.
Main Methods:
- Prospective, nonrandomized trial involving hospitalized patients receiving warfarin.
- Comparison of a baseline group (n=293) with an intervention group (n=217) using a detailed pharmacist-led warfarin dosing protocol.
- Analysis of warfarin dosing, INR values, and pharmacist-physician collaboration requirements.
Main Results:
- The intervention group showed a significantly lower defect rate (INR > 5) compared to the baseline group (1.85% vs. 7.85%).
- Fewer patients in the intervention group had an INR < 1.7 after four warfarin doses, indicating improved therapeutic control.
- Pharmacist-physician dosing discussions were needed in only 6% of intervention patients.
Conclusions:
- A pharmacist-administered warfarin dosing protocol effectively reduces overanticoagulation in hospitalized patients.
- This protocol improves therapeutic INR management without increasing underanticoagulation, while minimizing the need for physician intervention.
- Pharmacist-led warfarin management offers a safe and efficient strategy for hospitalized patients.
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