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评估临床药师在术前抗凝管理中的作用。

Evaluating the role of clinical pharmacists in pre-procedural anticoagulation management.

作者信息

Kataruka Akash, Renner Elizabeth, Barnes Geoffrey D

机构信息

a Department of Internal Medicine , Michigan Medicine , Ann Arbor , MI , USA.

b Department of Pharmacy Services , Michigan Medicine , Ann Arbor , MI , USA.

出版信息

Hosp Pract (1995). 2018 Feb;46(1):16-21. doi: 10.1080/21548331.2018.1420346. Epub 2017 Dec 28.

DOI:10.1080/21548331.2018.1420346
PMID:29283294
Abstract

OBJECTIVES

While physicians are typically responsible for managing perioperative warfarin, clinic pharmacists may improve pre-procedural decision-making. We assessed the impact of pharmacist-driven care for chronic warfarin-treated patients undergoing outpatient right heart catheterization (RHC).

METHODS

200 warfarin patients who underwent RHC between January 2012 and September 2015 were analyzed. Pharmacist-care (n = 79) was compared to the usual care model (n = 121). The primary outcome was a composite of (1) documentation of anticoagulation plan, (2) holding warfarin at least 5 days prior to procedure, (3) guideline-congruent low molecular weight heparin (LMWH) bridging, and (4) correct LMWH dosing if bridging deemed necessary. Chi-squared test performed to assess the role of pharmacist. A multivariable logistic regression analysis was performed to the composite endpoint, adjusted for the month of procedure.

RESULTS

Compared to the usual care model, pharmacist-driven care (OR 4.69, 95% CI 1.73-12.71, p = 0.002) and date of the procedure (OR 1.06/month, 95% CI 1.01-1.10, p = 0.011) were independently associated with the primary composite outcome. Of the individual outcome components, pharmacist-driven care was only associated with documentation (96.2% vs. 67.8%, OR 9.19, 95% CI 2.19-38.62, p = 0.002). Remaining components including hold warfarin for at least 5 days, appropriate bridging and correct LMWH dosing were not significantly associated with pharmacist-care.

CONCLUSIONS

Pharmacist-care is associated with better guideline-based anticoagulation management, but this was primarily driven by improved documentation. The impact of pharmacist managed peri-procedural anticoagulation on clinical outcomes remains unknown.

摘要

目的

虽然医生通常负责围手术期华法林的管理,但临床药师可能会改善术前决策。我们评估了药师主导的护理对接受门诊右心导管检查(RHC)的慢性华法林治疗患者的影响。

方法

分析了2012年1月至2015年9月期间接受RHC的200名华法林患者。将药师护理组(n = 79)与常规护理模式组(n = 121)进行比较。主要结局是以下各项的综合结果:(1)抗凝计划的记录;(2)术前至少停用华法林5天;(3)符合指南的低分子量肝素(LMWH)桥接;(4)若认为有必要进行桥接,则LMWH剂量正确。采用卡方检验评估药师的作用。对综合终点进行多变量逻辑回归分析,并根据手术月份进行调整。

结果

与常规护理模式相比,药师主导的护理(比值比4.69,95%置信区间1.73 - 12.71,p = 0.002)和手术日期(比值比1.06/月,95%置信区间1.

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