Noor Afnan, Khan Mansoor A, Warsi Ashraf, Aseeri Mohammed, Ismail Sherine
Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Haematology Department, Ministry of National Guard-Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Saudi Pharm J. 2021 Oct;29(10):1173-1180. doi: 10.1016/j.jsps.2021.08.015. Epub 2021 Aug 30.
Warfarin is the core component in the management of various thromboembolic disorders, which requires specialized expertise to optimize outcomes. There is limited data comparing a pharmacist vs. a haematologist-managed anticoagulation clinic in our setting, and in the Middle East. We aimed to evaluate the effectiveness and safety of a pharmacist vs. a haematologist-managed anticoagulation clinic in the Ambulatory Care Center at King Abdulaziz Medical City, Jeddah, Saudi Arabia.
A retrospective cohort study was conducted from 2016 to 2018, which included adult patients who have been followed-up for at least six months and who received warfarin for an extended period. The primary outcome was the proportion of time the patients in the two arms were in the therapeutic range. The secondary outcomes were the differences in expanded time in the therapeutic range, as well as the frequency of bleeding and thromboembolic events between the two arms.
We enrolled 104 and 124 patients in the pharmacist and haematologist arms respectively. The median time in the therapeutic range for the pharmacist arm was 71.4%, IQR (60.8-83.8) vs. 65%, IQR (43.5-79.1), in the haematologist arm (p = 0.0049). The median expanded time in the therapeutic range was 86.4%, IQR (77.5-95.3) vs. 81.21%, IQR (67.1-93.3) in the pharmacist vs. haematologist arm (p = 0.015) respectively. Major bleeding events occurred in 5.7 % vs. 3.2 %, and thromboembolic events in 5.7% vs. 4%, in the pharmacist vs. haematologist arm respectively.
Our results demonstrated that the time in the therapeutic range was significantly higher in the pharmacist arm, with no significant difference in bleeding and thromboembolic events compared to the haematologist arm.
华法林是治疗各种血栓栓塞性疾病的核心药物，需要专业知识来优化治疗效果。在我们所在地区以及中东地区，比较药剂师管理与血液科医生管理的抗凝门诊的数据有限。我们旨在评估沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城门诊护理中心药剂师管理与血液科医生管理的抗凝门诊的有效性和安全性。
进行了一项回顾性队列研究，时间跨度为2016年至2018年，纳入至少随访六个月且长期接受华法林治疗的成年患者。主要结局是两组患者处于治疗范围内的时间比例。次要结局是两组在治疗范围内延长时间的差异，以及出血和血栓栓塞事件的发生频率。
药剂师组和血液科医生组分别纳入了104例和124例患者。药剂师组处于治疗范围内的中位时间为71.4%，四分位间距（IQR）为（60.8 - 83.8），而血液科医生组为65%，IQR为（43.5 - 79.1）（p = 0.0049）。药剂师组与血液科医生组在治疗范围内的中位延长时间分别为86.4%，IQR（77.5 - 95.3）和81.21%，IQR（67.1 - 93.3）（p = 0.015）。药剂师组和血液科医生组的严重出血事件发生率分别为5.7%和3.2%，血栓栓塞事件发生率分别为5.7%和4%。
我们的结果表明，药剂师组处于治疗范围内的时间显著更长，与血液科医生组相比，出血和血栓栓塞事件无显著差异。
