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Nine-year experience with a pharmacist-managed anticoagulation clinic
American Journal of Hospital Pharmacy
|October 1, 1986
Summary
Pharmacist-managed anticoagulation clinics effectively control warfarin dosage, maintaining therapeutic prothrombin times with acceptable patient outcomes and low rates of bleeding and thromboembolic events.
Area of Science:
- Clinical Pharmacy
- Pharmacotherapy
- Cardiovascular Medicine
Background:
- Anticoagulation therapy, particularly with warfarin, requires careful management to balance efficacy and safety.
- Pharmacist-led clinics offer a potential model for optimizing anticoagulation control.
Purpose of the Study:
- To evaluate the outcomes of a pharmacist-managed anticoagulation clinic over a nine-year period.
- To assess the effectiveness of pharmacist-led warfarin dosage adjustments in maintaining therapeutic anticoagulation.
Main Methods:
- A pharmacist managed an anticoagulation clinic for ambulatory and inpatient cases.
- Warfarin dosage was adjusted to maintain prothrombin times within the therapeutic range (1.7-2.5 times normal).
- Patient outcomes, including prothrombin time control, hemorrhagic events, and thromboembolic events, were monitored.
Main Results:
- During the study period (1975-1984), 59.2% of prothrombin times fell within the therapeutic range.
- Low rates of major (0.002/patient-treatment month) and minor (0.05/patient-treatment month) hemorrhagic events were observed.
- The recurrence rate of thromboembolic events was 0.007 per patient-treatment month.
Conclusions:
- Pharmacist-managed anticoagulation clinics can achieve acceptable levels of anticoagulation control.
- This model of care resulted in a morbidity profile comparable to physician management.
- Pharmacist involvement in anticoagulation management is effective and safe.