Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy

Abstract

Background Warfarin is the most common oral anticoagulant drug, especially in low-income and emerging countries, because of the high cost of direct oral anticoagulant (DOACs), or when warfarin is the only proven therapy (mechanical prosthetic valve and kidney dysfunction). The quality of warfarin therapy is directly associated with dose management. Evidence shows that pharmaceutical care achieves a better quality of therapy with warfarin. However, there are no studies showing this intervention in a specific patient group with poor quality of anticoagulation in a long period after the end of the follow-up by a pharmacist. Thus, the aim of this study was to evaluate whether the quality of warfarin therapy driven by a pharmacist remains stable in the long term after the end of follow up with a pharmacist, in AF patients with poor quality of anticoagulation. Methods This is a prospective study, which evaluated about 2,620 patients and selected 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR<50% - based on the last three values of international normalized ratio). Pharmacist-driven therapy management was performed up to 12 weeks. Data from patients were evaluated 1 year after the end of the follow-up with pharmacist. Results Comparison between mean TTR after 12 weeks of pharmaceutical care (54.1%) and mean TTR one year after the end of the pharmaceutical care (56.5%; p=0.081) did not achieve statistical difference, demonstrating that the increment of quality due to intervention of 12 weeks was maintained for 1 year after intervention. Conclusion The long-term impact of pharmaceutical care was beneficial for patients with AF and poor quality of warfarin anticoagulation. This design might be an important strategy to treat a subgroup of patients without proven effectiveness of warfarin.

Pharmacotherapeutic follow-up of patients on warfarin in primary care: randomized clinical trial

“…Cases of thrombosis were more frequent in the CG, but the difference between groups did not achieve statistical significance. Another study achieved the minimization of these events through pharmacotherapeutic follow-up [6]. Risk factors associated with thromboembolic disorders found in the present study included hypertension, smoking, diabetes, dyslipidemia and an advanced age.…”

“…No association was found between receiving pharmacotherapeutic follow-up and an increase in TTR values in patients in anticoagulation therapy. However, previous studies have found such an association [5,6,17]. This divergence may be due to the fact that these studies were conducted in the hospital setting and/or anticoagulation clinics linked to cardiology services, involved multidisciplinary care teams and had larger samples, different follow-up methods and a greater frequency of INR measurements.…”

“…Follow-up through pharmaceutic care could improve the quality of treatment with warfarin [5,6] and could be an effective strategy for preventing, identifying and solving problems related to pharmacotherapeutic treatment [7]. Studies conducted in other countries have demonstrated the benefits of the engagement of the pharmacist in oral anticoagulation with warfarin [8,9].…”

Cost-Effectiveness of the Pharmacist-Managed Warfarin Therapy vs. Standard Care for Patients With Mechanical Mitral Valve Prostheses: An Egyptian Healthcare Perspective

“…This is backed by data from multiple studies that reported improved clinical outcomes with the pharmacist-managed warfarin therapy (PMWT) services, such as significantly better International Normalized Ratio (INR) control, and significant reductions in rates of emergency department visits, hospitalizations, hospital length of stay, and hospital readmission rates. In consequence, cost savings have been well demonstrated in studies from different sides of the world due to decreased rates of both adverse events and complications, with subsequent impact on medical and non-medical costs (12,(15)(16)(17)(18)(19)(20)(21). The objective of this trial-based economic evaluation study was to evaluate the clinical effectiveness and the cost-effectiveness of the PMWT services for outpatients with mechanical mitral valve prostheses (MMVPs) in an Egyptian University Teaching Hospital setting.…”