Outcomes of a Pharmacist Managed Anticoagulation Service

Objective: Managing patients on warfarin within a therapeutic range is complex due to factors that affect warfarin dosing, making it necessary to monitor patients closely and adjust medication doses to ensure maximal efficacy and minimal adverse events. The objectives of this study were to evaluate the effectiveness and safety of managing patients on warfarin by clinical pharmacists and physicians. Design: The study was a retrospective chart review. Setting: This study took place at the Internal Medicine Faculty Associates ambulatory care clinic affiliated with Atlantic Health System, which services patients in northern New Jersey. Participants: Patients were included in the study if they were seen at the clinic and prescribed warfarinfrom 2012 – 2014. Patients were divided into a pharmacist-managed armand the usual care arm. Measurements: The primary endpoint wastime in therapeutic range (TTR), calculated based on the Rosendaal method. Results: A total of 122 patients were included in the final analysis with 53 patients in the pharmacist-managed arm and 69 patients in the usual care arm. The calculated TTR was 66% for the pharmacist-managed arm and 56.6% for the usual care arm (p = 0.028). The number of INR tests per patient year was 19.59 in the pharmacistmanaged arm compared to 15.04 in the usual care arm (p = 0.0113). The percent of patients who had at least one INR > 4 was 28% in the pharmacist-managed arm and 45% in the usual care arm (p = 0.06). Conclusion: Pharmacist-management of warfarin led to a higher average TTR without any differences in supratherapeutic INRs.