Poon I O, Lal L, Brown E N, Braun U K
Pharmacy Department, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX 77004, USA.
J Clin Pharm Ther. 2007 Feb;32(1):21-9. doi: 10.1111/j.1365-2710.2007.00792.x.
Older adults frequently have conditions requiring oral anticoagulation. Although clearly benefiting from oral anticoagulation, they are at increased risk for bleeding complications. Regular monitoring to optimize anticoagulation and to reduce the chance of major bleeding complications is required. The impact of oral anticoagulation monitoring by pharmacists in patients older than 75 years of age has not been described well.
To compare warfarin therapy prescribed and monitored by physicians to a pharmacist-monitored anticoagulation service in a cohort of older veterans.
Retrospective chart review utilizing the Houston VA Medical Center's pharmacy database. Among all outpatients aged 75 years or older filling warfarin prescriptions between 1 March 2003 to 1 March 2005, and who were either monitored in a pharmacist's clinic or not, 103 patients per group were randomly selected. Information on demographics, indication for and length of warfarin therapy, INR values, and thromboembolic and bleeding events were abstracted. Differences were analysed using chi-squared test, Fisher's Exact test, and unpaired Student t-test.
A total of 1521 patients (440 in the pharmacist-monitored group, 1081 in the traditionally monitored group) met our inclusion criteria. One hundred and three patients per group were randomly selected for chart review. Although no significant difference in percentage of therapeutic INR values (48.1% pharmacist group, 46.4% conventional group) or in the incidence of major bleeding events was found, thromboembolic events occurred significantly less frequently in the pharmacist-monitored group (2 events vs. 12 events, P = 0.01). Minor bleeding events were more frequent in the pharmacist-monitored group (50 vs. 17, P < 0.01). However, time to follow-up after a sub- or supra-therapeutic INR was significantly shorter in the pharmacist monitored group (22 days vs. 68 days, and 14 days vs. 32 days, respectively).
Pharmacist-monitored anticoagulation was associated with reduced thromboembolic events, an increase in minor bleeding events, and no difference in major bleeding events. Overall such monitoring by pharmacists should be recommended for older adults.
老年人常有需要口服抗凝治疗的疾病。尽管口服抗凝治疗明显有益，但他们发生出血并发症的风险增加。需要定期监测以优化抗凝治疗并降低严重出血并发症的发生几率。药剂师对75岁以上患者进行口服抗凝监测的影响尚未得到充分描述。
在一组老年退伍军人中，比较医生开具并监测的华法林治疗与药剂师监测的抗凝服务。
利用休斯顿退伍军人事务医疗中心的药房数据库进行回顾性病历审查。在2003年3月1日至2005年3月1日期间开具华法林处方的所有75岁及以上门诊患者中，无论是否在药剂师诊所接受监测，每组随机选择103例患者。提取有关人口统计学信息、华法林治疗的指征和时长、国际标准化比值（INR）值以及血栓栓塞和出血事件的信息。使用卡方检验、Fisher精确检验和非配对学生t检验分析差异。
共有1521例患者（药剂师监测组440例，传统监测组1081例）符合纳入标准。每组随机选择103例患者进行病历审查。虽然在治疗性INR值的百分比（药剂师组为48.1%，传统组为46.4%）或严重出血事件的发生率方面未发现显著差异，但药剂师监测组的血栓栓塞事件发生频率明显较低（2例对12例，P = 0.01）。药剂师监测组的轻微出血事件更为频繁（50例对17例，P < 0.01）。然而，在INR低于或高于治疗范围后，药剂师监测组的随访时间明显更短（分别为22天对68天，以及14天对32天）。
药剂师监测的抗凝治疗与血栓栓塞事件减少、轻微出血事件增加以及严重出血事件无差异相关。总体而言，建议对老年人进行药剂师的此类监测。
