International Journal of Clinical Pharmacy

, Volume 35, Issue 5, pp 736–743 | Cite as

Comparing effectiveness of two anticoagulation management models in a Malaysian tertiary hospital

  • Subramaniam ThanimalaiEmail author
  • Asrul Akmal Shafie
  • Mohamed Azmi Hassali
  • Jeyaindran Sinnadurai
Research Article


Backgrounds Limited evidence is available regarding pharmacist managed anticoagulation clinic in the Southeast Asian region where there is marked difference in terms of care model, genetic composition and patient demographics. Objectives This study aimed at comparing the anticoagulation clinic managed by the pharmacist with physician advisory and the usual medical care provided in Kuala Lumpur Hospital (KLH) in terms of anticoagulation control and adverse outcomes. Setting A 2,302 bedded government tertiary referral hospital in Malaysia. Methods A 6-month retrospective cohort study of the effectiveness of two models of anticoagulation care, the pharmacist managed anticoagulation clinic which is known as warfarin medication therapy adherence clinic (WMTAC) and usual medical clinic (UMC) in KLH was conducted, where a random number generator was used to recruit patients. The UMC patients received standard medical care where they are managed by rotational medical officers in the physicians’ clinic. As for the WMTAC with physician advisory, the pharmacist will counsel and review the patients internationalised normalization ratio at each clinic visit and also adjust the patients’ warfarin dose accordingly. Patients are referred to physicians if immediate attention is required. Main outcome measure The main therapeutic outcome is time in therapeutic range (TTR) both actual and expanded TTR and thromboembolic and bleeding complications. Results Each of the WMTAC and usual medical care recruited 92 patients, which totals to 184 patients. The patient demographics in terms of age, race and indication of treatment were comparable. At the end of the 6 months follow-up, patients in the WMTAC group had significantly higher actual-TTR (65.1 vs. 48.3 %; p < 0.05) compared to those in usual medical care group. Rates of admission were 6.5 versus 28.2 events per 100 person-years for the WMTAC and UMC groups, respectively. Though the bleeding incidences were not significantly different, it was reduced. Conclusions These findings will impact local warfarin patient management services and policies because there was no available evidence supporting the role of pharmacists in the management of warfarin patients prior to this study.


Anticoagulation clinic Malaysia Pharmacists Therapeutic range Warfarin 



We would like to acknowledge and thank the Kuala Lumpur Hospital for granting permission to use the hospital and its resources to conduct this study. We gratefully acknowledge all of the hospital staff who contributed to the study and DAWN Clinical Software for the AC software used to provide the percentage of time within the therapeutic range calculations.


The research is funded by the University Sains Malaysia, Research University Grant. The author is sponsored by the Federal Training Grant, Ministry of Health for post-graduate research.

Conflicts of interest

No conflict of interest to declare.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Subramaniam Thanimalai
    • 1
    • 2
    Email author
  • Asrul Akmal Shafie
    • 3
  • Mohamed Azmi Hassali
    • 3
  • Jeyaindran Sinnadurai
    • 4
  1. 1.Kuala Lumpur HospitalKuala LumpurMalaysia
  2. 2.Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaGeorge TownMalaysia
  3. 3.School of Pharmaceutical SciencesUniversiti Sains MalaysiaGeorge TownMalaysia
  4. 4.Department of General MedicineKuala Lumpur HospitalKuala LumpurMalaysia

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