title: Comparing effectiveness of two anticoagulation management models in a Malaysian tertiary hospital.
abstract: BACKGROUND
  Limited evidence is available regarding pharmacist managed anticoagulation clinic in the Southeast Asian region where there is marked difference in terms of care model, genetic composition and patient demographics.
  
  
  OBJECTIVE
  This study aimed at comparing the anticoagulation clinic managed by the pharmacist with physician advisory and the usual medical care provided in Kuala Lumpur Hospital (KLH) in terms of anticoagulation control and adverse outcomes.
  
  
  METHODS
  A 2,302 bedded government tertiary referral hospital in Malaysia.
  
  
  METHODS
  A 6-month retrospective cohort study of the effectiveness of two models of anticoagulation care, the pharmacist managed anticoagulation clinic which is known as warfarin medication therapy adherence clinic (WMTAC) and usual medical clinic (UMC) in KLH was conducted, where a random number generator was used to recruit patients. The UMC patients received standard medical care where they are managed by rotational medical officers in the physicians' clinic. As for the WMTAC with physician advisory, the pharmacist will counsel and review the patients internationalised normalization ratio at each clinic visit and also adjust the patients' warfarin dose accordingly. Patients are referred to physicians if immediate attention is required.
  
  
  METHODS
  The main therapeutic outcome is time in therapeutic range (TTR) both actual and expanded TTR and thromboembolic and bleeding complications.
  
  
  RESULTS
  Each of the WMTAC and usual medical care recruited 92 patients, which totals to 184 patients. The patient demographics in terms of age, race and indication of treatment were comparable. At the end of the 6 months follow-up, patients in the WMTAC group had significantly higher actual-TTR (65.1 vs. 48.3 %; p < 0.05) compared to those in usual medical care group. Rates of admission were 6.5 versus 28.2 events per 100 person-years for the WMTAC and UMC groups, respectively. Though the bleeding incidences were not significantly different, it was reduced.
  
  
  CONCLUSIONS
  These findings will impact local warfarin patient management services and policies because there was no available evidence supporting the role of pharmacists in the management of warfarin patients prior to this study.
authors.affiliation: Kuala Lumpur Hospital, Jln. Pahang, 50586, Kuala Lumpur, Malaysia, subro6@gmail.com.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Thanimalai
authors.forename: Asrul Akmal
authors.initials: AA
authors.lastname: Shafie
authors.forename: Mohamed Azmi
authors.initials: MA
authors.lastname: Hassali
authors.forename: Jeyaindran
authors.initials: J
authors.lastname: Sinnadurai
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D015331:Cohort Studies; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008954:Models, Biological; D010044:Outpatient Clinics, Hospital; D010595:Pharmacists; D010607:Pharmacy Service, Hospital; D019095:Point-of-Care Systems; D012017:Referral and Consultation; D012189:Retrospective Studies; D012306:Risk; D062606:Tertiary Care Centers; D013923:Thromboembolism / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000078329:Workforce
chemical_list: D000925:Anticoagulants; D014859:Warfarin