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Assessment of oral anticoagulation control at two pharmacist-managed clinics in Brazil

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Abstract

Background Warfarin remains widely used by patients with cardiovascular diseases. When using warfarin, the quality of oral anticoagulation control is a critical determinant to minimize the risk of bleeding and thromboembolic events. Pharmacist engagement in patient care is relevant towards improving the quality of warfarin therapy. Objective To assess the quality of oral anticoagulation control measured by time in therapeutic range (TTR) at two pharmacist-managed anticoagulation clinics (AC). Method This study included adults with indication of continuous warfarin use. Patients were recruited at two AC of public hospitals in Brazil (2014–2015). Anticoagulation control was assessed by TTR using the Rosendaal method. Laboratory INR values were collected for the maximum period of follow-up (2009–2015). Results A total of 554 patients were studied. The median age was 63.7 [Quartile 1 (Q1) 54.3; Quartile 3 (Q3) 73.6] years, 57.4% female. The median TTR was 64.3% [Q1 54.0%; Q3 74.0%], and 344 (61.6%) patients had TTR ≥ 60%. Conclusion Pharmacist-managed AC have achieved an adequate TTR in Brazilian patients with low socioeconomic status. Interventions include face-to-face appointments for individual patient education, warfarin-dosing adjustments and monitoring of drug interactions. Pharmacists are important to improve adherence and the quality of warfarin therapy in low- and middle income countries.

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References

  1. Connolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG, et al. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation. 2008;118(20):2029–37.

    Article  CAS  PubMed  Google Scholar 

  2. van Walraven C, Jennings A, Oake N, Fergusson D, Forster AJ. Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest. 2006;129(5):1155–66.

    Article  PubMed  Google Scholar 

  3. Thanimalai S, Shafie AA, Hassali MA, Sinnadurai J. Comparing effectiveness of two anticoagulation management models in a Malaysian tertiary hospital. Int J Clin Pharm. 2013;35(5):736–43.

    Article  CAS  PubMed  Google Scholar 

  4. Manji I, Pastakia SD, Do AN, Ouma MN, Schellhase E, Karwa R, et al. Performance outcomes of a pharmacist-managed anticoagulation clinic in the rural, resource-constrained setting of Eldoret, Kenya. J Thromb Haemost. 2011;9(11):2215–20.

    Article  CAS  PubMed  Google Scholar 

  5. Viquez-Jaikel A, Victoria H, Ramos-Esquivel A. Improvement of time in therapeutic range with warfarin by pharmaceutical intervention. Int J Clin Pharm. 2017;39(1):41–4.

    Article  CAS  PubMed  Google Scholar 

  6. Chua WB, Cheen HH, Kong MC, Chen LL, Wee HL. Modelling the cost-effectiveness of pharmacist-managed anticoagulation service for older adults with atrial fibrillation in Singapore. Int J Clin Pharm. 2016;38(5):1230–40.

    Article  PubMed  Google Scholar 

  7. Kaatz S, Ahmad D, Spyropoulos AC, Schulman S. Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. J Thromb Haemost. 2015;13(11):2119–26.

    Article  CAS  PubMed  Google Scholar 

  8. Rosendaal FR, Cannegieter SC, van der Meer FJ, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993;69(3):236–9.

    CAS  PubMed  Google Scholar 

  9. Dlott JS, George RA, Huang X, Odeh M, Kaufman HW, Ansell J, et al. National assessment of warfarin anticoagulation therapy for stroke prevention in atrial fibrillation. Circulation. 2014;129(13):1407–14.

    Article  CAS  PubMed  Google Scholar 

  10. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Rogério Guimarães de Lima Silva, Caryne Margotto Bertollo, Isadora Gonçalves Ferreira, Luisa Caldeira Brant & Maria Auxiliadora Parreiras Martins

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  1. Rogério Guimarães de Lima Silva
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  2. Caryne Margotto Bertollo
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  3. Isadora Gonçalves Ferreira
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  4. Luisa Caldeira Brant
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  5. Maria Auxiliadora Parreiras Martins
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Correspondence to Maria Auxiliadora Parreiras Martins.

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None of the authors have had financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.

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de Lima Silva, R.G., Bertollo, C.M., Ferreira, I.G. et al. Assessment of oral anticoagulation control at two pharmacist-managed clinics in Brazil. Int J Clin Pharm 39, 1157–1161 (2017). https://doi.org/10.1007/s11096-017-0511-x

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  • DOI: https://doi.org/10.1007/s11096-017-0511-x

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