title: Adherence and outcomes of patients treated with dabigatran: pharmacist-managed anticoagulation clinic versus usual care.
abstract: OBJECTIVE
  The results of a study to determine whether pharmacist monitoring in the crucial first months of dabigatran therapy in patients with atrial fibrillation or flutter can help optimize adherence and stroke-prevention outcomes are presented.
  
  
  METHODS
  A retrospective preimplementation-postimplementation study was conducted at a Veterans Affairs (VA) hospital to evaluate dabigatran adherence and treatment outcomes in a group of patients whose therapy was monitored by anticoagulation clinic (ACC) pharmacists (n = 20) and a historical comparison group (n = 48) that received usual care (UC). The primary endpoint was the medication possession ratio (MPR) averaged across each group over three months (acceptable adherence was defined as an MPR of ≥80%); three secondary endpoints (dabigatran-related bleeding and incident stroke and venous thromboembolism) were evaluated.
  
  
  RESULTS
  Relative to the UC group, ACC-monitored patients were significantly more likely to have undergone recommended baseline laboratory tests before dabigatran initiation (p = 0.02). ACC patients were also more likely to have MPR values of ≥80% at the end of the three-month follow-up period (25% of patients versus 10% of patients), although the difference was not statistically significant; the mean MPR values in the ACC-monitored and UC groups were 93.1% and 88.3%, respectively. Aside from one episode of major gastrointestinal bleeding, none of the evaluated adverse outcomes occurred in either group.
  
  
  CONCLUSIONS
  VA patients treated with dabigatran for nonvalvular atrial fibrillation or flutter and followed by a pharmacist-managed ACC did not differ significantly from similar patients receiving UC in the proportion adherent with dabigatran therapy or in the frequency of minor or major bleeding episodes. Thromboembolic events and strokes were absent in both groups.
authors.affiliation: Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (119), Palo Alto, CA 94304, USA. pei-yu.lee@va.gov
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Lee
authors.forename: Sora Y
authors.initials: SY
authors.lastname: Han
authors.forename: Randell K
authors.initials: RK
authors.lastname: Miyahara
mesh_terms: D000328:Adult; D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001282:Atrial Flutter / Q000188:drug therapy*; D001562:Benzimidazoles / Q000008:administration & dosage*; D002140:California; D000069604:Dabigatran; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010593:Pharmaceutical Services; D012189:Retrospective Studies; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome; D015091:beta-Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran