The Ohio State University General Internal Medicine Clinics, 2050 Kenny Road Suite 2335, Columbus, OH 43221, United States of America; The Ohio State University College of Pharmacy, 500 W. 12th Avenue, Columbus, OH 43210, United States of America.
The Ohio State University General Internal Medicine Clinics, 2050 Kenny Road Suite 2335, Columbus, OH 43221, United States of America.
Thromb Res. 2022 Sep;217:52-56. doi: 10.1016/j.thromres.2022.07.004. Epub 2022 Jul 16.
Patients taking warfarin require frequent international normalized ratio (INR) monitoring in healthcare settings, putting them at increased risk of Coronavirus disease 2019 (COVID-19) exposure during the pandemic. Thus, strategies to limit in-person visits to healthcare facilities were recommended by the Anticoagulation Forum. The objective of this study was to describe the number and types of changes made to anticoagulation therapy as a result of pharmacist intervention during the COVID-19 pandemic.
A retrospective chart review of patients included in a primary care COVID-19 anticoagulation intervention was conducted. During this intervention, pharmacists provided individualized recommendations for anticoagulation changes in patients taking warfarin to limit their healthcare facility exposure while also maintaining safe anticoagulation management practices.
As a result of pharmacist intervention, 83 (55.7 %) of the 149 patients included in the intervention had changes in anticoagulation including: switching to a direct oral anticoagulant (n = 12), extending the INR monitoring interval (n = 48), switching to home INR monitoring (n = 21), or stopping anticoagulation (n = 2). For those patients who were taking warfarin for the entire 6 months pre- and post-intervention, the total number of healthcare facility and laboratory visits with an INR completed decreased from 8.8 to 6.4 (p < 0.001) per patient without a statistically significant decrease in time in therapeutic range (p = 0.76).
This study depicts rapid implementation of a population health-based approach to assess all patients taking warfarin for options to minimize healthcare visits and decrease risk for COVID-19 exposure. Methods to reduce healthcare visit burden while maintaining patient safety should be considered as a regular component of anticoagulation management post-pandemic.
接受华法林治疗的患者在医疗保健环境中需要频繁进行国际标准化比值（INR）监测，这使他们在大流行期间感染 2019 年冠状病毒病（COVID-19）的风险增加。因此，抗凝论坛建议采取策略来限制前往医疗机构的就诊次数。本研究的目的是描述由于药剂师在 COVID-19 大流行期间的干预，华法林治疗的抗凝方案发生了哪些变化。
对参与初级保健 COVID-19 抗凝干预的患者进行了回顾性图表审查。在这种干预措施中，药剂师针对服用华法林的患者提供了抗凝调整的个性化建议，以限制他们在医疗机构的暴露，同时保持安全的抗凝管理实践。
由于药剂师的干预，干预组中 149 名患者中有 83 名（55.7%）的抗凝方案发生了变化，包括：改用直接口服抗凝剂（n=12）、延长 INR 监测间隔（n=48）、改为在家监测 INR（n=21）或停止抗凝（n=2）。对于那些在干预前后的 6 个月内一直服用华法林的患者，每位患者完成的与 INR 相关的医疗机构和实验室就诊次数从 8.8 次减少到 6.4 次（p<0.001），而治疗范围内的时间没有统计学意义上的减少（p=0.76）。
本研究描述了迅速实施一种基于人群健康的方法，以评估所有服用华法林的患者，以选择尽量减少医疗机构就诊次数并降低 COVID-19 暴露风险的方案。在大流行后，应考虑减少医疗就诊负担同时保持患者安全的方法，作为抗凝管理的常规组成部分。
