College of Pharmacy, Qatar University, Doha, Qatar.
Pharmacy Department, Alwakra Hospital, Doha, Qatar.
J Eval Clin Pract. 2016 Jun;22(3):433-8. doi: 10.1111/jep.12504. Epub 2016 Jan 14.
RATIONALE, AIMS AND OBJECTIVES: For over 60 years, warfarin has been the mainstay anticoagulant used in the outpatient setting for the prevention and treatment of a wide variety of thromboembolic clinical conditions. Guidelines recommend that health care providers managing oral anticoagulation therapy should do so in a systematic and coordinated fashion. Studies have shown that, when compared to traditional doctor-based anticoagulation management, pharmacist-managed anticoagulation services can improve patient outcomes. The first pharmacist-based anticoagulation clinic in Qatar was launched in 2013 at Alwakra Hospital. The primary objective of this research was to evaluate the impact of pharmacist versus doctor-based anticoagulation management on the percentage time under therapeutic INR (International Normalized Ratio; TTR), INR within therapeutic range and the extreme out of range INRs.
A retrospective cohort study was designed to compare the anticoagulation control of pharmacist-based warfarin clinic to the usual doctor-care.
Data from 278 patients taking warfarin (78 managed at pharmacist and 200 at doctor-based clinic) were evaluated. Subjects followed at the pharmacist-based clinic had a superior TTR compared to those managed at the doctor-based clinic (81.8% vs. 69.8%, P < 0.001). Additionally, the percentage of visits within therapeutic range were significantly higher in the pharmacist's group compared to doctor's group (76.5% vs. 71.2%, P = 0.011). At the same time, percentage of visits with extreme subtherapeutic INR was reduced in the pharmacist-managed clinic (5.17% vs. 7.05%, P = 0.007) CONCLUSIONS: Our study indicates that pharmacist-based anticoagulation has better INR control when compared to the traditional anticoagulation management. Pharmacist-managed anticoagulation clinics should be considered and supported for warfarin management.
背景、目的和目标：60 多年来，华法林一直是用于门诊抗凝治疗的主要药物，可预防和治疗多种血栓栓塞性临床疾病。指南建议管理口服抗凝治疗的医疗保健提供者应以系统和协调的方式进行抗凝治疗。研究表明，与传统的基于医生的抗凝管理相比，药剂师管理的抗凝服务可以改善患者的治疗效果。卡塔尔第一家基于药剂师的抗凝诊所于 2013 年在 Alwakra 医院开业。这项研究的主要目的是评估基于药剂师与基于医生的抗凝管理对治疗性 INR（国际标准化比值；TTR）、INR 治疗范围内和极端超范围 INR 比例的影响。
设计了一项回顾性队列研究，以比较基于药剂师的华法林诊所与常规医生护理的抗凝控制效果。
共评估了 278 名服用华法林的患者（78 名在药剂师管理的诊所，200 名在医生管理的诊所）的数据。与在医生管理的诊所相比，在药剂师管理的诊所中，患者的 TTR 更好（81.8% vs. 69.8%，P<0.001）。此外，药剂师组的治疗范围内就诊百分比明显高于医生组（76.5% vs. 71.2%，P=0.011）。同时，在药剂师管理的诊所中，极端亚治疗性 INR 的就诊百分比降低（5.17% vs. 7.05%，P=0.007）。
我们的研究表明，与传统的抗凝管理相比，基于药剂师的抗凝治疗具有更好的 INR 控制效果。应考虑并支持药剂师管理的抗凝诊所用于华法林管理。
