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Improving clinical outcomes for hospital patients initiated on warfarin


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Bereznicki, LRE, Jackson, SL, Morgan, SM, Boland, C, Marsden, KA, Jupe, DML, Vial, JH and Peterson, GM 2007 , 'Improving clinical outcomes for hospital patients initiated on warfarin' , Journal of Pharmacy Practice and Research, vol. 37, no. 4 , pp. 295-305 .

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Background: Studies have demonstrated that the risk of
warfarin-related complications is highest in the first 90 days of
treatment, while quality audits suggest that warfarin initiation
protocols are not always adhered to.
Aim: To improve the quality of anticoagulation for hospital
patients initiated on warfarin.
Method: A warfarin drug chart, incorporating the hospital's
warfarin initiation protocol, was implemented on four target
medical and cardiothoracic wards. The chart was used to
record international normalised ratios (INRs) and prescribe
warfarin, and was faxed to the patient's GP on discharge.
Warfarin initiations on the target wards immediately postintroduction
of the warfarin drug chart were reviewed and
compared to the pre-intervention data collected over a 17month
Results: The pre-intervention and post-intervention groups
included 271 and 183 patients initiated on warfarin, respectively.
The intervention was associated with fewer warfarin-related
complications (thromboembolism, major bleeding) occurring
within a 90-day follow-up period (2.1%vs 11%; adjusted OR
0.24; 95%CI 0.07-0.85; P= 0.03), largely driven by a reduction
in the incidence of major bleeding (0.7% vs 7.1 %; adjusted
OR 0.17; 95%CI 0.02-1.45; P = 0.05). Adherence to the
warfarin initiation protocol improved significantly from 36% to
71%(p < 0.01) in the pre- and post-intervention data collection
periods, respectively. Post-intervention, the proportion of
patients with an INR > 4 and the proportion of patients who
required a warfarin dose to be withheld was reduced from
8.5% and 13%, to 3.8% (p < 0.05) and 6.6% (p = 0.02),
Conclusion: Adherence to an age and disease based warfarin
initiation protocol, and improving the quality of discharge
information for patients initiated on warfarin, significantly
improved patient outcomes.

Item Type: Article
Authors/Creators:Bereznicki, LRE and Jackson, SL and Morgan, SM and Boland, C and Marsden, KA and Jupe, DML and Vial, JH and Peterson, GM
Journal or Publication Title: Journal of Pharmacy Practice and Research
Publisher: Society of Hospital Pharmacists Australia
ISSN: 1445-937X
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