Key result
A pharmacist-led anticoagulation management service significantly increased the percentage of INRs within the goal range compared to physician-led management (57.5% vs 50.0%; P=0.0004).
Why the study?
Does a pharmacist-led anticoagulation management service improve the percentage of INRs in therapeutic range compared to a physician-led service in patients receiving warfarin?
Observational (n=226)
Yes
Does a pharmacist-led anticoagulation management service improve the percentage of INRs in therapeutic range compared to a physician-led service in patients receiving warfarin?
Absolute Event Rate: 57.5% vs 50%
p-value: p=.0004
A pharmacist-led anticoagulation management service significantly improves the percentage of INRs in the therapeutic range and reduces out-of-range results compared to physician-led management.
May support pharmacist integration in anticoagulation clinics; leaves open need for randomized confirmation before practice change.
BACKGROUND: The safety and efficacy of warfarin depend on maintaining the international normalized ratio (INR) in an established range. OBJECTIVE: The purpose was to determine whether a coordinated pharmacist-led approach improved percentage of INRs in therapeutic range in comparison to a physician-led anticoagulation management service (AMS). METHODS: A retrospective chart review was conducted for patients at a multisite primary care organization. INR data for patients receiving warfarin management by a physician were collected from December 1, 2009 to May 31, 2010. These were compared to INR results from December 1, 2010 to May 31, 2011, during which patients received warfarin management from a pharmacist. The primary end points were percentage of INRs within a goal range of 2.0 to 3.0 and an expanded goal range of 1.8 to 3.2 for the physician-led group versus the pharmacist-led group. RESULTS: The percentage of INR results within the goal range (2.0-3.0) was greater among patients in the pharmacist-led group (n = .130) than the physician-led group (n = 96; 57.5% vs 50.0%, respectively; P = .0004). The percentage of INR results <1.5 (7.3% vs 5.1%) and >3.5 (11.4% vs 7.1%) was also statistically significant in favor of the pharmacist-led AMS, with P values of .03 and .0004, respectively. CONCLUSION: A pharmacist-led AMS improved the percentage of INRs in range, with significantly less out-of-range results.
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Gupta et al. (2013) conducted an observational in Warfarin management (n=226). Pharmacist-led anticoagulation management service vs. Physician-led anticoagulation management service was evaluated on Percentage of INRs within a goal range of 2.0 to 3.0 (p=.0004). A pharmacist-led anticoagulation management service significantly increased the percentage of INRs within the goal range compared to physician-led management (57.5% vs 50.0%; P=0.0004).
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