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Pharmacist-led anticoagulant dosing service in an inpatient setting: management of supratherapeutic INRs
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2014 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Introduction: Warfarin is the most widely prescribed anticoagulant for preventing and treating thromboembolism. Treatment with warfarin is complex and presents many challenges. In June 2013 the General Medical Unit (GMU) at the Alfred Hospital introduced pharmacist-led inpatient warfarin dosing. In this study, the compliance to Alfred Health’s warfarin guideline, in regards of managing supratherapeutic INR was assessed before and after pharmacist started dosing.  Aim: To assess the effectiveness of a pharmacist-led anticoagulant dosing service for the management of inpatients receiving warfarin and experiencing a supratherapeutic INR.  Methods: This was a retrospective study of patients admitted to GMU Oct12 - Mar13 (physician-led, pre–implementation) and Oct13 – Mar14 (pharmacist-led, post- implementation). Patients were included if they received warfarin and had at least one supratherapeutic INR. Management of supratherapeutic INR was compared to the recommended management as outlined in the Alfred Health Anticoagulation Guideline. Results: In pre-implementation 62 patient’s experienced 122 supratherapeutic INR’s, in post-implementation 63 patients experienced 164 supratherapeutic INR’s. The two groups were similar in age (p=0.87), length of stay (p=0.51) and indication for anticoagulation (p=0.67). A non-statistically significant improvement in the proportion of supratherapeutic INR with appropriate management was demonstrated in the pharmacist-led service (77.7 % pre-implementation vs 86.0% post-implementation; p=0.069). The average number of supratherapeutic INRs per patient increased for the post-implementation group (p=0.047). Conclusion:  Pharmacist-led management resulted in a non-statistically improvement in compliance with the Guideline in the inpatient setting, however there were more supratherapeutic INRs observed. Further research is required to clarify the impact of this service initiative. 

Place, publisher, year, edition, pages
2014. , 39 p.
Keyword [en]
warfarin, pharmacist-led, guideline, inpatient
National Category
Social and Clinical Pharmacy
URN: urn:nbn:se:uu:diva-231596OAI: oai:DiVA.org:uu-231596DiVA: diva2:745002
External cooperation
Department of Pharmacy, Alfred Hospital, Australia
Subject / course
Available from: 2014-09-10 Created: 2014-09-09 Last updated: 2014-09-10Bibliographically approved

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