Assessment of oral anticoagulation control at pharmacist-managed clinics: A retrospective cohort study.

In chronic kidney disease (CKD) patients, the ratio of warfarin enantiomers is changed and becomes unstable due to a reduction of cytochrome P450 (CYP) 2C9 activity of, which contributes to the development of hemorrhagic complications. The aim of this study was to investigate the influence of interventions by clinical pharmacists in addition to guidance by physicians on time in therapeutic range (TTR) control of warfarin therapy for CKD patients with non-valvular atrial fibrillation (NVAF). This retrospective cohort study included NVAF patients with CKD admitted and discharged from a cardiovascular internal medicine ward between March 2011 and July 2013 in Yokosuka Kyousai Hospital. Participants were classified into two groups according to the instructions by clinical pharmacists and physicians (intervention group) and by physicians only (usual care group). The primary outcome was TTR. Secondary outcomes were major bleeding and minor bleeding. In total, 39 participants (28 males, 11 females; mean age: 72.1 years) were classified into the intervention (n = 16) and usual care (n = 23) groups. TTR in the intervention group was significantly higher than in the usual care group. Major bleeding and minor bleeding were not significantly different between the two groups. The intervention of clinical pharmacists with anticoagulation therapy can lead to a proper use of warfarin prescribed by physicians.