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Pharmacist warfarin

Geoffrey D Barnes, Erin Mouland
Peri-procedural management of oral anticoagulants can be complex and confusing for many providers. It involves a careful balance of a patient's thromboembolic risk and bleeding risk. For every patient chronically taking an oral anticoagulant who will be undergoing an elective procedure, a four step approach may be considered when creating a plan for the oral anticoagulant.(Writing Group M, 20161 ) Does the oral anticoagulant need to stop for the procedure?(Periprocedural Management of Anticoagulation Writing C, Doherty JU, Gluckman TJ, et al...
March 10, 2018: Progress in Cardiovascular Diseases
Subramaniam Thanimalai, Asrul Akmal Shafie, Mohamed Azmi Ahmad Hassali, Jeyaindran Sinnadurai
BACKGROUND: Systematic anticoagulation management clinic is recommended to manage patients on chronic warfarin therapy. In Malaysia, the service was introduced as warfarin medication therapy adherence clinic (WMTAC), which is managed by pharmacists with a physician advisory. OBJECTIVES: To assess the cost-effectiveness of WMTAC in comparison with usual medical clinic (UMC), which is managed by medical officers in Kuala Lumpur Hospital, a tertiary referral hospital in Malaysia...
July 17, 2017: Value in Health Regional Issues
Sara Meirinho, Ricardo Relvas, Gilberto Alves
BACKGROUND: Epistaxis is an active nose bleeding with a population occurrence of approximately 60%. Although epistaxis is a common clinical complaint, the majority of the cases are benign and caused by local induced factors (e.g., trauma and local inflammation). Nevertheless, it is also recognised that epistaxis can be induced after some drugs intake. AIMS: Due to the increasing use of drugs or drug combinations that potentially may induce epistaxis, this review aims to alert healthcare professionals for this often neglected adverse drug effect and its possible complications...
February 12, 2018: Current Drug Safety
Farzaneh Ashrafi, Najmeh Rezaie, Sarah Mousavi
Objective: Dabigatran etexilate is a novel oral anticoagulant with several advantages over warfarin such as no need for routine monitoring and fewer drug interactions. This drug was added to our hospital's formulary in 2012. The objective of this study was to assess the rational drug use of dabigatran at a large teaching hospital. Methods: A prospective cross-sectional study was performed from November to June 2015 at Alzahra teaching hospital, Isfahan, Iran. All patients who received at least one dose of dabigatran were eligible for inclusion...
October 2017: Journal of Research in Pharmacy Practice
Samantha J Ingram, Charlotte L Kirkdale, Sian Williams, Elaine Hartley, Susan Wintle, Valerie Sefton, Tracey Thornley
BACKGROUND: As part of the NHS desire to move services closer to where people live, and provide greater accessibility and convenience to patients, Brighton and Hove Clinical Commissioning Group (CCG) underwent a review of their anticoagulation services during 2008. The outcome was to shift the initiation and monitoring service in secondary care for non-complex patients, including domiciliary patients, into the community. This was achieved via a procurement process in 2008 resulting in the Community Pharmacy Anticoagulation Management Service (CPAMs) managed by Boots UK (a large chain of community pharmacies across the United Kingdom)...
February 7, 2018: BMC Health Services Research
Elise Phelps, Thomas Delate, Daniel M Witt, Paul B Shaw, Kathleen H McCool, Nathan P Clark
BACKGROUND: Clinical pharmacy anticoagulation services have improved the quality of anticoagulant therapy and are associated with lower rates of bleeding and thromboembolism compared to usual care. Several studies have found that higher time-in-therapeutic range (TTR) during warfarin therapy is associated with better warfarin outcomes. However, whether increasing TTR over time within an established anticoagulation service is associated with further reduction in bleeding and thromboembolic outcomes is unknown...
January 21, 2018: Thrombosis Research
Nermine S Choumane, Diana N Malaeb, Bassem Malaeb, Souheil Hallit
BACKGROUND: Health care professionals (HCP) are known key elements of effective patient's counselling and education. For patients taking warfarin, education about the dose, side effects, and toxicity is clearly identified as a cornerstone of achieving improved health and quality of life. The study objective was to evaluate the patients' knowledge about warfarin and assess the impact of the health care professionals' counselling in enhancing patients' knowledge in achieving warfarin therapeutic outcomes...
February 1, 2018: BMC Health Services Research
Brett A Faine, Julie Amendola, Jordan Homan, Azeemuddin Ahmed, Nicholas Mohr
PURPOSE: Results of a study of anticoagulation reversal agent availability in rural and community hospital emergency departments (EDs) are reported. METHODS: A cross-sectional telephone survey was conducted to test the hypothesis that anticoagulation reversal agents are not commonly stocked in low-volume EDs. In phase 1 of the study, a physician, pharmacist, or nurse manager at a sample of EDs in 1 state was surveyed to characterize anticoagulation reversal agent availability and the presence or absence of reversal protocols; in phase 2, follow-up qualitative interviews were conducted with hospital pharmacists selected by purposive sampling to identify barriers to availability...
January 15, 2018: American Journal of Health-system Pharmacy: AJHP
Tuesdy Horner, Charles E Mahan
Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Anticoagulation is used in patients with VTE to reduce the risk of recurrent VTE and VTE-related death. The overall incidence of VTE is 1 to 2 per 1000 person-years. Long-term mortality for patients with VTE is poor, with 25% of patients not surviving 7 days and nearly 40% not surviving the first year. Coagulation disorders demand effective anticoagulant therapy to avoid complications, especially recurrent VTE and VTE-related death...
December 2017: American Journal of Managed Care
Akash Kataruka, Elizabeth Renner, Geoffrey D Barnes
OBJECTIVES: While physicians are typically responsible for managing perioperative warfarin, clinic pharmacists may improve pre-procedural decision-making. We assessed the impact of pharmacist-driven care for chronic warfarin-treated patients undergoing outpatient right heart catheterization (RHC). METHODS: 200 warfarin patients who underwent RHC between January 2012 and September 2015 were analyzed. Pharmacist-care (n = 79) was compared to the usual care model (n = 121)...
February 2018: Hospital Practice (Minneapolis)
Natalie M Weir, Rosemary Newham, Emma D Corcoran, Ashwag Ali Atallah Al-Gethami, Ali Mohammed Abd Alridha, Paul Bowie, Anne Watson, Marion Bennie
OBJECTIVE: The Scottish Patient Safety Programme - Pharmacy in Primary Care collaborative is a quality improvement initiative adopting the Institute of Healthcare Improvement Breakthrough Series collaborative approach. The programme developed and piloted High Risk Medicine (HRM) Care Bundles (CB), focused on warfarin and non-steroidal anti-inflammatories (NSAIDs), within 27 community pharmacies over 4 NHS Regions. Each CB involves clinical assessment and patient education, although the CB content varies between regions...
November 21, 2017: Research in Social & Administrative Pharmacy: RSAP
Sireen Abdul Rahim Shilbayeh, Wejdan Ali Almutairi, Sarah Ahmed Alyahya, Nouf Hayef Alshammari, Eiad Shaheen, Alya Adam
Background Although it can result in serious complications due to its narrow therapeutic index, warfarin is widely used in the treatment and prevention of thromboembolic disorders. However, patients' adherence and knowledge are determinants of therapeutic success. Objective We sought to validate instruments to provide a reliable means of identifying gaps in patient understanding and nonadherence to inform targeted pharmacists' interventions to improve these measures. Methods A cross-sectional survey was conducted...
November 30, 2017: International Journal of Clinical Pharmacy
Siavash Piran, Sam Schulman, Mohamed Panju, Menaka Pai
Direct oral anticoagulant (DOAC) use is increasing worldwide. However, if not taken or prescribed correctly, DOACs have serious side effects. It is crucial that healthcare providers (HCPs) offer patients accurate information and counselling around DOACs, to optimize safe and effective use. To assess knowledge around oral anticoagulant indication, dosing, storage, and administration, an electronic survey was distributed to HCPs across Canada from June to August 2017, with 18 questions on the practical use of oral anticoagulants...
January 2018: Journal of Thrombosis and Thrombolysis
Salihah Aidit, Yee Chang Soh, Chuan Seng Yap, Tahir M Khan, Chin Fen Neoh, Shazwani Shaharuddin, Yaman W Kassab, Rahul P Patel, Long C Ming
Objective: To evaluate the impact of pharmacist-led warfarin management and standardized treatment protocol. Methods: A retrospective cohort study was carried out in a cardiology referral hospital located in central Kuala Lumpur, Malaysia, from 2009 to 2014. The inclusion criteria were: adult patients who were diagnosed and treated for atrial fibrillation (AF) with warfarin, attended the warfarin medication therapy adherence clinic (WMTAC) for at least 12 weeks, and with at least four international normalized ratio (INR) readings...
2017: Frontiers in Pharmacology
Amy L Awker, Melissa A Bell, Megan McGraw, Mark A Klein
PURPOSE: The effect of education regarding new evidence in periprocedural anticoagulation, with a focus on reducing use in patients at only moderate thromboembolic risk, is presented. METHODS: A retrospective cohort analysis and quasiexperimental design were used. The initial review identified the current state of practice regarding bridging anticoagulation. Education was then provided to primary care providers and pharmacists on recent evidence. A subsequent review was completed to assess the impact of this education on clinical decision-making...
December 1, 2017: American Journal of Health-system Pharmacy: AJHP
Jen-Yu Chang, Chi-Chuan Wang, Hao-Cheng Kang, Li-Jiuan Shen, Chih-Fen Huang
Objective: To investigate the cost-effectiveness of the first patient self-paying pharmacist-assisted warfarin monitoring (PAWM) program in Taiwan. Design: A Markov model with a 1-month cycle length and a 20-year time horizon was employed in this study. The model is composed of the following eight states: three no-event states (i.e. 'subtherapeutic,' 'within therapeutic' and 'supratherapeutic' states), two serious adverse events (AEs) (i.e. bleeding and thromboembolism), two sequelae states and death...
August 22, 2017: International Journal for Quality in Health Care
Taesong An, Eiji Kose, Akihiko Kikkawa, Hiroyuki Hayashi
Background/Aims Our previous study showed that time in therapeutic range (TTR) control of warfarin therapy was negatively affected in non-valvular atrial fibrillation (NVAF) patients with heart failure. This study assesses the effect of intervention by hospital pharmacists on TTR control in Japanese NVAF patients with heart failure. Method This retrospective cohort study included NVAF patients with heart failure admitted and discharged from the cardiovascular internal medicine ward between March 2011 and July 2013...
2017: Journal of Medical Investigation: JMI
Rogério Guimarães de Lima Silva, Caryne Margotto Bertollo, Isadora Gonçalves Ferreira, Luisa Caldeira Brant, Maria Auxiliadora Parreiras Martins
Background Warfarin remains widely used by patients with cardiovascular diseases. When using warfarin, the quality of oral anticoagulation control is a critical determinant to minimize the risk of bleeding and thromboembolic events. Pharmacist engagement in patient care is relevant towards improving the quality of warfarin therapy. Objective To assess the quality of oral anticoagulation control measured by time in therapeutic range (TTR) at two pharmacist-managed anticoagulation clinics (AC). Method This study included adults with indication of continuous warfarin use...
December 2017: International Journal of Clinical Pharmacy
Laney K Jones, Gerard Greskovic, Dante M Grassi, Jove Graham, Haiyan Sun, Michael R Gionfriddo, Michael F Murray, Kandamurugu Manickam, Douglas C Nathanson, Eric A Wright, Michael A Evans
PURPOSE: Pharmacists' involvement in a population health initiative focused on chronic disease management is described. SUMMARY: Geisinger Health System has cultivated a culture of innovation in population health management, as highlighted by its ambulatory care pharmacy program, the Medication Therapy Disease Management (MTDM) program. Initiated in 1996, the MTDM program leverages pharmacists' pharmacotherapy expertise to optimize care and improve outcomes. MTDM program pharmacists are trained and credentialed to manage over 16 conditions, including atrial fibrillation (AF) and multiple sclerosis (MS)...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
Aileen Chu, Jill Limberg
OBJECTIVE: To evaluate the impact of a rivaroxaban discharge initiative on the efficacy and safety of acute venous thromboembolism treatment in emergency department patients. PRACTICE INNOVATION: Patients discharged on rivaroxaban from the emergency department were provided extensive counseling along with a commercially-available medication dose pack by the ED pharmacist. Patients were contacted by phone until they had obtained outpatient follow-up and remained adherent to anticoagulation beyond the initial first month of treatment...
December 2017: American Journal of Emergency Medicine
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