The Journal of Informed Pharmacotherapy 2004;15:407.
Mildred Tang, B.Sc.(Pharm), Joanne Jung, B.Sc.(Pharm), Glen Brown, Pharm.D.
Pharmacy Department, Providence Health Care, Vancouver, British Columbia
Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 2003.
To compare the effectiveness of pharmacists versus physician dosage adjustments for warfarin in obtaining therapeutic anti-coagulation in hemodialysis patients who are stabilized on warfarin. The primary endpoint was the percentage of INR’s within the therapeutic target range.
A major Canadian tertiary adult acute care teaching hospital.
The study was a “before-after” design with patients serving as their own control and data was compared between physician dosing (before) and pharmacist dosing (after). Pharmacists utilized a warfarin dosing nomogram as a guide in addition to patient specific historical data to manage therapy while physicians dosed independently.
A total of 18 patients met inclusion criteria after enrolling in the study. From these patients, the pharmacists ordered and evaluated 367 INR’s compared to 496 INR’s for the physicians. The mean (SD) proportion of INR’s within the target range for the pharmacists’ arm compared to physician arm was 55% +/- 22 versus 43% +/- 21 respectively. There was a statistically significant difference between the two arms (mean difference = 12%, p=0.033, 95% CI 1-23).
Pharmacists were superior to physicians in achieving the desired degree of anticoagulation through the dosage adjustments of warfarin.
Acknowledgements: Kelly Mahannah, B.Sc.(Pharm), Andria Lee, B.Sc.(Pharm), Gael Robertson, B.Sc.(Pharm)
Copyright © 2003 by the Journal of Informed Pharmacotherapy. All rights reserved.