NUR 01.7 - Evaluation of Pharmacist-Led Anticoagulation Service in Patients Receiving Warfarin: Experience from Ethiopian Tertiary Care Hospital

Background: Pharmacist-led anticoagulation management services are becoming the preferred practice to achieve a better quality of care for patients receiving anticoagulants that require frequent monitoring.

Aims: To evaluate the impact of pharmacist-led anticoagulation services (PLAS) at the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia, among patients receiving warfarin in long-term care.

Methods: A retrospective cohort study was conducted on 218 patients receiving warfarin at the Pharmacist-Led Anticoagulation Clinic (PLAC) of TASH. The Rosendaal method was used to calculate time in the therapeutic range (TTR). A TTR ≥ 65% was used as the cut-off range for good anticoagulation control. The TTR was the primary outcome while bleeding, thromboembolic events and complications, hospitalization, and emergency department visits were secondary outcomes in this study. Factors associated with low TTR were investigated by bivariate and multivariate logistic regression models. Data was analyzed by the Statistical Package for Social Science version 26.

Results: The mean (SD) TTR was 58.81% (±23.29%), and 42.67% of the patients achieved ≥ 65% TTR. 73.29% of the time, clinical pharmacists adjusted warfarin doses correctly. Forty-one minor bleedings and ten thromboembolic events were reported during the follow-up period. Ten all-cause emergency department visits and hospitalizations were recorded in 10 and 14 patients, respectively. The odds of suboptimal TTR were reduced by 77% and 3% among participants in the age range of 45–64 years compared with those in the age range of 12–30 years (AOR: 0.23; 95% CI: 0.09–0.59), and for every increase in the frequency of INR monitoring (AOR: 0.97, 95% CI: 0.95-0.99), respectively.

Conclusion(s): The PLAS can improve anticoagulation outcomes in patients receiving warfarin therapy in long-term care. In-depth understanding, further multicenter studies, and PLAS expansion to other hospitals could benefit patients receiving warfarin in the country.