Clinical outcomes of pharmacist-managed care for inpatients with warfarin at Bangkok Metropolitan Administration General Hospital

Abstract

Previous studies suggested that providing anticoagulation management services by pharmacist improved anticoagulation control in outpatients who uses warfarin. However, few studies evaluated hospitalized patients. Purpose of this study is to assess the impact of additional pharmacist-managed care to usual care in inpatient treating with warfarin. This study was a quasi-experimental study. Patients in intervention group were monitored by a clinical pharmacist who recommended warfarin dose, screened and managed drug therapeutic problems related to warfarin therapy, suggested monitoring plan and provided patient education. Results of intervention group were compared to historical control (usual care). A total of 92 patients were included (49 cases in control group and 43 patients in intervention group). Baseline data were not significantly different between two groups. Percentage of patients with international normalized ratio (INR) in target at first followed-up visit in the intervention group was more than those in the control group (60.47% vs. 30.61%, p = 0.015). In control group, one patient had bleeding during admission and 4 patients readmitted due to adverse effect of supratherapeutic warfarin level. On the contrary, there was no adverse event found in the intervention group. The results of this study suggest that coordination with clinical pharmacists and physicians improved quality of treatment among inpatients receiving warfarin and reduced complications of warfarin use.