Outcome Analysis of Anticoagulant Therapy in Critical Care Unit: The Need for a Pharmacy Managed Anticoagulant Service

Background: In our center, NCTCE, there are 2 intensive care units (general and cardiac), where critically ill patients are admitted and managed.Anticoagulation is usually indicated in such patients for atrial fibrillation, valve replacement and DVT prophylaxis.Objective: To determine the role of a clinical pharmacist in the therapeutic and clinical appraisal of such patients on anticoagulation.Materials and Method: Over a 2-year period (June 2015 -May 2017), a study design to determine the role of a clinical pharmacist in anticoagulant treatment was made in both ICU.This was a prospective longitudinal study.Here, demography, the anticoagulation on which interventions were made on, duration of admission, areas and determinants of a clinical pharmacist's interventions were incorporated.Others included, were levels of intervention, acceptance and rejection of the interventions as well as the outcome.Results: During the study period, 168 patients were used.Male (72) and female (96), with a female to male ratio of 1:1.3.Indications for anticoagulation were DVT prophylaxis (14.88%), valves (83.90%) and AF (1.10%).Among the anticoagulants on which interventions were made on, warfarin was the highest (53.57%) while heparin was the least (2.90%).Duration of admission ranged from 2-40 days.Areas of intervention were on effectiveness of therapy (18.70%), drug-drug interactions (16.43%), adverse events (32.86%), dosage (11.05%),Kidney function (1.70%), adherence (6.70%) and drug selection (2.27%).Levels of intervention were at prescriber (30.51%), drug (38.56%),patient (25.42%) and laboratory (5.51%).The outcome was that majority of patients (78.74%) had their problems resolved.Conclusion: Anticoagulation therapy of patients in ICU requires precise damaging, monitoring and appropriate patient education so as to ensure that patients benefit maximally.A clinical pharmacist has a vital role to play in the above areas.