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Effect of Standardized Warfarin Treatment Protocol on Anticoagulant Effect: Comparison of a Warfarin Medication Therapy Adherence Clinic with Usual Medical Care

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Aidit, S, Soh, YC, Yap, CS, Khan, TM, Neoh, CF, Shaharuddin, S, Kassab, YW, Patel, RP ORCID: 0000-0001-9344-1013 and Ming, LC ORCID: 0000-0002-6971-1383 2017 , 'Effect of Standardized Warfarin Treatment Protocol on Anticoagulant Effect: Comparison of a Warfarin Medication Therapy Adherence Clinic with Usual Medical Care' , Frontiers in Pharmacology, vol. 8, no. Nov , pp. 1-9 , doi: 10.3389/fphar.2017.00637.

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Abstract

Objective: To evaluate the impact of pharmacist-led warfarin management andstandardized treatment protocol.Methods: A retrospective cohort study was carried out in a cardiology referral hospitallocated in central Kuala Lumpur, Malaysia, from 2009 to 2014. The inclusion criteriawere: adult patients who were diagnosed and treated for atrial fibrillation (AF) withwarfarin, attended the warfarin medication therapy adherence clinic (WMTAC) for atleast 12 weeks, and with at least four international normalized ratio (INR) readings.The electronic medical records were reviewed for demographics, type of AF, warfarindose, INRs, adverse events, co-morbidities, and drug–drug interactions. The outcomemeasures included the mean time to therapeutic INR, the mean percentage of time intherapeutic range (TTR), bleeding events, and common drug interactions.Results: Out of 473 patients, 151 patients fulfilled the inclusion criteria. The findingsrevealed that there were significant associations between the usual medical care (UMC)group and pharmacist-led WMTAC in terms of TTR (p = 0.01) and INR (p = 0.02)levels. A positive impact of pharmacists’ involvement in the WMTAC clinic was wherethe “pharmacist’s recommendation accepted” (p = 0.01) and “expanded therapeuticINR range” (p = 0.04) were statistically significantly higher in the WMTAC group.Conclusion: There was a significant positive association between the pharmacistledWMTAC and anticoagulation effect (therapeutic TTR, INR). The identified findingsrevealed that expanded role of pharmacist in pharmacist-managed warfarin therapy isbeneficial to optimize the warfarin therapy. This study also highlighted the critical rolesthat pharmacists can actively play to ensure optimal anticoagulation pharmaceuticalcare.

Item Type: Article
Authors/Creators:Aidit, S and Soh, YC and Yap, CS and Khan, TM and Neoh, CF and Shaharuddin, S and Kassab, YW and Patel, RP and Ming, LC
Keywords: Anticoagulant
Journal or Publication Title: Frontiers in Pharmacology
Publisher: Frontiers Research Foundation
ISSN: 1663-9812
DOI / ID Number: 10.3389/fphar.2017.00637
Copyright Information:

Copyright 2017 The AuthorsLicensed under Creative Commons Attribution 4.0 International (CC BY 4.0)https://creativecommons.org/licenses/by/4.0/

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