Theory And Practice Exploration Of Pharmaceutical Care Provided By Clinical Pharmacist During The Whole Process Of Warfarin Anticoagulant Therapy

Warfarin is a widely used classic oral anticoagulant, which is effective and inexpensive, but with a narrow therapeutic window and markedly individual differences. The main adverse reactions like bleeding and thrombosis will present when inappropriately used. In the United State, the successful management of warfarin anticoagulant therapy is performed by a Anticoagulation Clinic with the participation of clinical pharmacists, doctors, and nurses. So far there is no unified and practical anticoagulant pharmaceutical care model in China. Thus, this study aim to explore the optimal pharmaceutical care model during the whole process of warfarin anticoagulant therapy in theory and practice.Firstly, to evaluate the quality of anticoagulant therapy in patients taking warfarin, a retrospective analysis of related clinical data of 214 patients who meet the inclusion criteria was performed. Results showed that the average TTR of the 214 patients was (50.80±22.32)%. TTR> 70%, indicating the quality of warfarin anticoagulant therapy was the best, accounted for 20.09%; 58%≤ TTR≤ 70%, indicating the quality of warfarin anticoagulant therapy was acceptable, accounted for 20.09%; TTR< 58%, indicating the quality of warfarin anticoagulant therapy was relatively inferior, accounted for up to 59.82%. The quality of anticoagulant therapy in patients taking warfarin wasn’t good enough, which was consistent with the results done by cardiology department of our hospital. Hence we need to strengthen the management to make sure the safety and effectiveness of anticoagulant therapy.Secondly, study on the correlation and consistency of INR results between CoaguChek XS and Sysmex CA7000/CS5100 was implemented. Results showed that relative differences between INR of two methods was -11%<(INRc-INRs)/INRs≤15%, accounted for 81.1%; correlation coefficient r=0.970 (P< 0.001), κ=0.646, meaning the correlation and consistency of INR result between CoaguChek XS and Sysmex CA7000/CS5100 were good. Bland-Altman plots showed that the consistency was not so good when (INRc+INRs)/2> 4.0. The turn around time of Sysmex CA7000/CS5100 testing was (178.58 ±45.59) min, much longer than that of CoaguChek XS 1 min. This results suggested that CoaguChek XS could be an complementary INR monitoring method for patients taking warfarin.Furthermore, to explore a practical pharmaceutical care model during the whole process of warfarin anticoagulant therapy, clinical pharmacist did clinical pharmacy practice in vascular surgical ward and cardiology clinic. After doctor prescribed warfarin, clinical pharmacist provided series of pharmaceutical care services for patients, such as checking medication prescriptions, evaluating and managing drug-drug/food interactions, educating patients, monitoring adverse drug reactions, establishing medication history, assisting doctors in adjusting warfarin dose according to INR value and genetic testing results, and so on.It can be concluded that 1) The quality of anticoagulant therapy in patients taking warfarin wasn’t good enough, which was consistent with the results done by cardiology department of our hospital, so we need to strengthen the management to make sure safety and effectiveness.2) Good correlation and consistency were observed between CoaguChek XS and Sysmex CA7000/CS5100 when INR<4.0. CoaguChek XS can save turn around time, and can be a complementary INR monitoring method for patients taking Warfarin.3) Clinical pharmacist can provide series of pharmaceutical care services for patients, such as educating patients, monitoring adverse drug reactions, evaluating and managing drug-drug/food interactions, assisting doctors in adjusting warfarin dose according to INR value and genetic testing results, and so on.