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Impact of clinical pharmacist intervention in anticoagulation clinic in Sudan

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Abstract

Background Many trials have compared anticoagulation management provided by a pharmacist led anticoagulation clinic versus usual physician care showing the role for clinical pharmacist in the management of anticoagulant therapy, and demonstrating excellent outcomes. In Sudan, there is no published research evaluating the role of pharmacist in providing pharmaceutical care for patients taking warfarin. Objective The objective of the study is to assess the role of clinical pharmacist intervention in warfarin patients compared to usual medical care. Setting This study was conducted in Ahmed Gasim cardiac surgery and renal transplant center warfarin clinic. Methods One hundred thirty-five patients were randomly selected from adult patients on warfarin therapy The history of INR records, and adverse effects for the past year, were recorded. Then patients’ warfarin dose adjustments according to INR, was done by the clinical pharmacist for one year. Patients received continuous verbal education and written information about warfarin. Main outcome measure The primary outcome for this study was the INR control, while the secondary outcomes were the bleeding events and hospitalization due to warfarin. Results After the clinical pharmacist intervention there was significant (P < 0.01) improvement in INR control and a significant (P < 0.05) reduction in incidence of bleeding after clinical pharmacist intervention. Hospitalization due to warfarin related complications (bleeding, high INR, low INR) was also significantly (P < 0.001) reduced. Conclusion Clinical pharmacists intervention in warfarin therapy improve INR control, reduce bleeding and hospitalization due to warfarin complications.

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References

  1. Koda-Kimble MA, Young YL, Alldredge BK, Corelli RL, Guglielmo BJ, Kradjan WA et al. Applied therapeutics: the clinical use of drugs. 9th ed. USA, Lippincott Williams & Wilkins. 2009. P. 15/2-15/34. ISBN 978-0-7817-6555-8.

  2. Chicholm-Burns MA, Wells BG, Schwinghammer TL, Malone PM, Kolesar JM, Rotschafer JC et al. Pharmacotherapy principles and practice. New York: McGraw-Hill Companies. 2008. p.133-160. ISBN 0-07-150977-1.

  3. Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy Apathophysiologic Approach. 7th ed. New York:McGraw-Hill Companies. 2008. p. 331-372. ISBN 0-07-164325-7.

  4. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158(15):1641–7.

    Article  CAS  Google Scholar 

  5. Ryan F, Byrne S, O’Shea S. Managing oral anticoagulation therapy: improving clinical outcomes. J Clin Pharm Ther. 2008;33(6):581–90.

    Article  CAS  PubMed  Google Scholar 

  6. Dipiro JT. Anticoagulation clinical pharmacy practice, In: Patricia HS, editor. Encyclopedia of clinical pharmacy. (e-book): USA, Marcel Dekker; 2003. p 63–70. ISBN-10: 0824707524.

  7. Damaske DL, Baird RW. Development and implementation of a pharmacist-managed inpatient warfarin protocol. Baylor Univ Med Center Proc. 2005;18(4):397–400.

    Google Scholar 

  8. Witt DM, Shanahan RL, Mazzoli G, Tillman DJ. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest. 2005;127(5):1515–22.

    Article  PubMed  Google Scholar 

  9. Bond CA, Raehl CL. Pharmacist-provided anticoagulation management in United States hospitals: death rates, length of stay, Medicare charges, bleeding complications, and transfusions. Pharmacotherapy. 2004;24(8):953–63.

    Article  CAS  PubMed  Google Scholar 

  10. Tschol N, Lai DKS, Tilley JA, Wong H, Brown GR. Comparison of physician- and pharmacist-managed warfarin sodium treatment in open heart surgery patients. Can J Cardiol. 2003;19(12):1413–7.

    PubMed  Google Scholar 

  11. Schillig J, Kaatz S, Hudson M, Krol GD, Szandzik EG, Kalus JS. Clinical and safety impact of an inpatient pharmacist-directed anticoagulation service. J Hosp Med. 2011;6(6):322–8.

    Article  PubMed  Google Scholar 

  12. Young S, Bishop L, Twells L, Dillon C, Hawboldt J, O’Shea P. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic, BMC family practice. 2011; 12:88 (e-journal). http://bmcfampract.biomedcentral.com/articles/10.1186/1471-2296-12-88. Accessed December 5 2016.

  13. Rudd Kelly M, Dier John G. Comparison of two different models of anticoagulation management services with usual medical care. Pharmacotherapy. 2010;03(4):330–8.

    Article  Google Scholar 

  14. Dager WE, Branch JM, King JH, White RH, Quan RS, Musallam NA, Albertson TE. Optimization of inpatient warfarin therapy: impact of daily consultation by a pharmacist-managed anticoagulation service. Ann Pharmacother. 2000;34(5):567–72.

    Article  CAS  PubMed  Google Scholar 

  15. Anila KN, Emmanuel J. Study on impact of clinical pharmacist improving knowledge of cardiology out- patients about oral anticoagulant. Indian J Pharm Pract. 2013;6(1):31–5.

    Google Scholar 

  16. Gray DR, Garabedian-Ruffalo SM, Chretien SD. Cost-justification of a clinical pharmacist-managed anticoagulation clinic. Ann Pharmacother. 2007;41(3):496–501.

    Article  PubMed  Google Scholar 

  17. Ernst ME, Brandt KB. Evaluation of 4 years of clinical pharmacist anticoagulation case management in a rural, private physician office. J Am Pharm Assoc. 2003;43(5):630–636.

  18. Hasan SS, Shamala R, Syed IA, Basariah N, David WK, Chong DWK, Mei TK, Chin OH. Factors affecting warfarin-related knowledge and INR control of patients attending physician- and pharmacist-managed anticoagulation clinics. J Pharm Pract. 2011;24(5):485–93.

    Article  PubMed  Google Scholar 

  19. Epplen K, Dusing-Wiest M, Freedlund J, Harger N, Kathman S, Ivey MF. Stepwise approach to implementing ambulatory clinical pharmacy services. Am J Health Syst Pharm. 2007;64(9):945–51.

    Article  PubMed  Google Scholar 

  20. Locke C, Ravnan SL, Patel R, Uchizono JA. Reduction in warfarin-associated adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service. Pharmacotherapy. 2005;25(5):685–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to show our gratitude to the patients who agreed to participate in this study, and to the center laboratory staff for their cooperation and patience.

Funding

There was no specific funding received for this research.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Faculty of Pharmacy, Qassim University, Al-Malida, Kingdom of Saudi Arabia

    Nahid Osman Ahmed

  2. Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, P.O. Box 1996, Khartoum, Sudan

    Bashier Osman

  3. Ahmed Gasim Cardiac Surgery and Renal Transplant Center, Khartoum, Sudan

    Yassein Mohamed Abdelhai

  4. Department of Pharmacology, Faculty of Pharmacy, International University of Africa, Khartoum, Sudan

    Tariq Muhammed Hashim El-Hadiyah

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  1. Nahid Osman Ahmed
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  2. Bashier Osman
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  3. Yassein Mohamed Abdelhai
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  4. Tariq Muhammed Hashim El-Hadiyah
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Correspondence to Nahid Osman Ahmed.

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Ahmed, N.O., Osman, B., Abdelhai, Y.M. et al. Impact of clinical pharmacist intervention in anticoagulation clinic in Sudan. Int J Clin Pharm 39, 769–773 (2017). https://doi.org/10.1007/s11096-017-0475-x

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  • DOI: https://doi.org/10.1007/s11096-017-0475-x

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