Magazine article Drug Topics

Study Shows Benefit of Pharmacy-Run Anticoagulation Service

Magazine article Drug Topics

Study Shows Benefit of Pharmacy-Run Anticoagulation Service

Article excerpt

Pharmacists pushing for greater involvement in patient care have new support from Henry Ford Hospital in Detroit. A 2-year study found that a pharmacy-directed anticoagulation service boosted the quality and efficiency of care for heparin-induced thrombocytopenia (HIT) in patients using direct thrombin inhibitors (DTTs). This may be the first before-and-after study on the safety and efficiency of DTT use by primary care teams compared to a pharmacist-directed anticoagulation service.

"What we have done is to put pharmacists in charge of outcomes for all of our patients on anticoagulation," said James Kalus, PharmD, senior clinical pharmacy manager at Henry Ford and principal investigator on the study. "Pharmacists are uniquely qualified to fill this role. We understand pharmacodynamics and pharmacokinetics and the patientspecific factors that contribute to response. We are just beginning to figure out some of the opportunities to insert the pharmacist at the bedside,"

HIT is a recognized problem in the inpatient population, affecting up to 3% of patients on heparin. The actual rate of HtT could be higher as doser patient monitoring tends to uncover more borderline thrombocytopenia associated with heparin use. Patients with confirmed or suspected HtT are typically taken off all heparin products and placed on DTI therapy, either argatroban (Argatroban, Glaxo SmithKline), lepirudin (Refludan, Berlex Labs), or bivalirudin (Angiomas, The Medicines Company).

Problems with DTIs

The problems with all 3 DTIs indude an extremely narrow therapeutic window and different organ toxidties, Kalus said. Patients must reach anticoagulation target levels quickly and maintain appropriate therapeutic levels to avoid thromoboembolic complications, amputations, or death.

During the study there were significant improvements in target levels of time to anticoagulation, 6.4 hours versus 18.9 hours (Pc.001), and time within therapeutic range, 84,7% versus 64,4% (FcOOl), with pharmacists running Henry Ford's anticoagulation service. The study used matched case controls from 2005 to 2007, when primary care teams oversaw all aspects of inpatient anticoagulation therapy.

But the key improvement resulting from pharmadst oversight of anticoagulation might have been an increase in positive HIT assays from 55,4% to 75.6% (P=,0005). That means more patients were treated appropriately and avoided potentially serious adverse events. …

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