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Utility of a pharmacist-managed Anticoagulation Program in patients with congenital heart disease

Meredith J O'Neil1, BreAnn N Garr1, Jenna M Faircloth2

  • 1Division of Pharmacy, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Cardiology in the Young
|September 8, 2023
PubMed

Insights

A pharmacist-managed anticoagulation program significantly improved warfarin management in pediatric heart patients, increasing time in therapeutic range by 15% over nine years. This consistent model enhances clinical outcomes for children with congenital heart disease (CHD).

Area of Science:

  • Cardiology
  • Pharmacology
  • Pediatric Medicine

Background:

  • Warfarin is a crucial anticoagulant for patients with congenital heart disease (CHD).
  • Managing warfarin therapy can be complex, necessitating optimized care models.
  • A shift from a multidisciplinary to a centralized pharmacist-led anticoagulation team was implemented.

Purpose of the Study:

  • To describe the patient cohort managed by a centralized anticoagulation program.
  • To evaluate the impact of a pharmacist-managed model on warfarin therapy effectiveness.
  • To assess improvements in time in therapeutic range (TTR) as a marker of clinical outcomes.

Main Methods:

  • A single-centre retrospective cohort study design.
  • Comparison of TTR before and after implementing a pharmacist-managed model.
  • Paired t-test used for statistical analysis of TTR data.

Main Results:

  • Implementation of the pharmacist-managed model increased TTR from 65.7% to 80.2% (p < .001).
  • This significant improvement in TTR was sustained from 2013 to 2022.
  • The 2022 cohort included 119 patients, primarily those with mechanical valve replacement (68%).

Conclusions:

  • A collaborative, centralized, pharmacist-managed model enhances warfarin management in CHD patients.
  • This practice change resulted in a sustained 15% increase in TTR over nine years.
  • The pharmacist-led model demonstrates improved clinical outcomes for pediatric anticoagulation therapy.
Abstract

Keywords:
CHDWarfarinanticoagulationpediatricpharmacist

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