The first pharmacist-based warfarin-monitoring service in Iran

Abstract

Objective A growing body of evidence indicates that pharmacist-based anticoagulation clinics can have equal and sometimes superior outcomes to those obtained through standard care. This paper assesses the adequacy of anticoagulation and the effect of consultation services in the first pharmacist-managed anticoagulation clinic in Iran. Method The anticoagulation clinic of Masih Daneshvari Hospital was established by a clinical pharmacist. During a 14-month period all patients on warfarin therapy were referred to our clinic. Patients were monitored and consulted based on predetermined guidelines. The primary clinical outcome was the control of international normalized ratio (INR) within the therapeutic range. Data were gathered on the indication of warfarin therapy, the pharmacist's interventions, and the adverse drug effects experienced by the participants. Key findings A total of 76 patients were included: 42.1% (age 50 ± 17 years, mean ± SD) were male. The primary indications for warfarin were treatment of deep-vein thrombosis or pulmonary emboli (46.1%) and mechanical valve replacement (23.7%). The main reason for referral of patients to clinic was routine monitoring (32.9%) and INR control (31.3%). The most common intervention by pharmacists was increasing the dose (31.6%). Of the referred patients 47.7% reached the target INR on follow-up visits, whereas 11.8% were not within the desired range. None of the clinical interventions performed by physicians for management of bleeding was compatible with guidelines. There was a trend between proper use of warfarin and reaching the target of INR control (odds ratio 2.97, P = 0.09). Conclusion The results of this study demonstrate that a clinical-pharmacist-managed anticoagulation clinic offers not only safe and effective treatment but also is superior with respect to increased anticoagulation control.