Witt Daniel M, Humphries Tammy L
Clinical Pharmacy Anticoagulation Service, Kaiser Permanente Colorado Region, Westminster, CO 80234, USA.
J Thromb Thrombolysis. 2003 Apr;15(2):113-8. doi: 10.1023/b:thro.0000003325.62542.43.
Analysis of the outcomes associated with episodes of excessive anticoagulation (international normalized ratio [INR] > 6.0) managed by physicians in a group model health maintenance organization (HMO) revealed opportunities for improvement. A centralized, telephone follow-up Clinical Pharmacy Anticoagulation Service (CPAS) was later implemented in the same HMO. We sought to compare the outcomes of excessive anticoagulation episodes managed by CPAS pharmacists to traditional physician management.
Computerized laboratory information was used to identify episodes of excessive anticoagulation managed by CPAS clinical pharmacists during the 6-month study. Pertinent data were collected through retrospective medical record review. Results were compared to a similar analysis conducted prior to CPAS implementation (traditional management).
A total of 313 INR episodes >6.0 were identified in the CPAS group compared to 301 in the traditional management group. 6.3% of patients in the traditional management group experienced major bleeding compared to 1.3% in the CPAS group (p = 0.001). The majority of excessive anticoagulation episodes in both groups were managed by temporarily withholding warfarin therapy. Phytonadione was administered more frequently in the traditional management group than the CPAS group, 17.0% vs. 6.4%, respectively (p < 0.001). Traditional management patients also received higher doses of phytonadione than CPAS patients, 13.0 mg vs. 3.3 mg, respectively (p < 0.001). Aggressive use of phytonadione in the traditional management group resulted in two episodes of iatrogenic thromboembolism while no such episodes occurred in the CPAS group.
The management of excessive anticoagulation by a centralized telephone follow-up anticoagulation service staffed by clinical pharmacists resulted in improved clinical outcomes compared to traditional management.
对在团体模式健康维护组织（HMO）中由医生管理的过度抗凝发作（国际标准化比值[INR]＞6.0）相关结果的分析揭示了改进的机会。随后在同一HMO中实施了集中式电话随访临床药学抗凝服务（CPAS）。我们试图比较由CPAS药师管理的过度抗凝发作结果与传统医生管理的结果。
利用计算机化实验室信息识别在6个月研究期间由CPAS临床药师管理的过度抗凝发作。通过回顾性病历审查收集相关数据。将结果与CPAS实施前进行的类似分析（传统管理）进行比较。
CPAS组共识别出313次INR＞6.0的发作，而传统管理组为301次。传统管理组6.3%的患者发生大出血，而CPAS组为1.3%（p = 0.001）。两组中大多数过度抗凝发作通过暂时停用华法林治疗进行管理。传统管理组比CPAS组更频繁地给予维生素K1，分别为17.0%和6.4%（p＜0.001）。传统管理组患者接受的维生素K1剂量也高于CPAS组患者，分别为13.0 mg和3.3 mg（p＜0.001）。传统管理组中积极使用维生素K1导致两例医源性血栓栓塞发作，而CPAS组未发生此类发作。
与传统管理相比，由临床药师提供的集中式电话随访抗凝服务对过度抗凝的管理产生了更好的临床结果。
