Pharmacist-Managed Anticoagulation Services for Warfarin Management in Tertiary Hospitals:The Egyptian Experience

Background:Warfarin is widely regarded as the main anticoagulant in lowering the risk of thromboembolism.This study used indicators to compare pharmacist-managed anticoagulation services,using a well-prepared protocol,with physician-managed anticoagulation services・Methods:A retrospective prospective pilot study was conducted to compare patient outcomes before and after transitioning patients to phannacist-managed anticoagulation services,comparing the proportion of those with therapeutic international normalized ratio(INK),subtherapeutic INK,and supratherapeutic INR,as well as their bleeding occurrences as indicators of assuring quality care.Results:A significant improvement in anticoagulation management was noted in the transition to pharmacist-managed anticoagulation services.The proportion of those with subtherapeutic INR decreased from 61.8%to 11.8%(p<0.001),those with supratherapeutic INR decreased from 20.6%to 2.9%(p<0.001),those with therapeutic INR increased from 17.6%to 85.3%(p<0.001),and the occurrence of bleeding decreased from 11.8%to 0.0%,without significant difference in warfarin doses(median from 4 before the transition to 5 after);in addition,the time to reach therapeutic INR decreased from 12-24 weeks to 2-8 weeks after transitioning to pharmacist-managed anticoagulation services.Conclusion:Pharmacist-managed anticoagulation services are considered safer and more effective than physician-managed anticoagulation services alone in terms of patientsJ adherence and satisfaction,which provide an excellent opportunity for quality assurance care.

Anticoagulation control in atrial fibrillation patients present to outpatient clinic of cardiology versus anticoagulant clinics

Nonvalvular atrial fibrillation (NVAF) is the most common sustained cardiacarrhythmia in clinical practice, which if untreated results in a doubling of cardiovascularmorbidity and mortality. AF is an independent predictor of stroke, with an annual risk 5 to 6 timeshigher than patients in sinus rhythm. During recent years, several randomised clinical trialsconducted by investigators around the world involving 13 843 participants with NVAF havedemonstrated convincingly the value of warfarin therapies for stroke prevention in high riskpatients. However, the dose response of warfarin is complex and its activity is easily altered byconcurrent medications, food interactions, alcohol and illnesses. Adherence to medical advice androutine monitoring of the international normalized ratio (INR) is important, because lowanticoagulant intensity predisposes the patients to thromboembolic complications and high intensityto haemorrhage. Studies suggested that anticoagulant clinics could improve the quality ofanticoagulation control, and anticoagulant clinics are common in western countries. However, inChina, most AF patients taking warfarin usually attend the outpatient clinic of cardiology, whilethe quality of anticoagulation control is never investigated. We therefore assessed anticoagulationcontrol in the outpatient clinic of cardiology, and the quality of anticoagulation control since theestablishment of anticoagulant clinics.