title: Evaluating warfarin management by pharmacists in a community teaching hospital.
abstract: OBJECTIVE
  The purpose of this study was to evaluate warfarin management by pharmacists compared with physicians through an inpatient anticoagulation management service (AMS).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Community teaching hospital.
  
  
  METHODS
  Patients were randomly selected from the Inpatient AMS from January 1, 2009 to January 1, 2011. Patients were included if they were 18 of age years or older and received warfarin for at least three days and excluded for indefinite warfarin discontinuation or an indication following orthopedic surgery. A total of 179 patients were included in each group.
  
  
  METHODS
  The electronic medical record was reviewed for demographics, warfarin indication and goal range, international normalized ratios (INRs), albumin, drug-drug interactions, bleeding, and thrombotic rates.
  
  
  METHODS
  Primary endpoints included mean time to therapeutic INR, mean time within goal, frequency of supratherapeutic INRs, bleeding, thrombotic rates, and mean INR on discharge.
  
  
  RESULTS
  There was no statistically significant difference in the time required to reach a therapeutic INR; 3.17 vs. 2.65 days (95% confidence interval -0.09-1.13; P = 0.093). However, the pharmacist group resulted in a lower frequency of supratherapeutic INRs and significantly more time within goal range.
  
  
  CONCLUSIONS
  Similar results were observed for pharmacist-managed and physician-managed patients for INR monitoring and outcome rates. However, the pharmacist-managed patients demonstrated a lower incidence of supratherapeutic INRs and significantly more time within goal.
authors: MedStar Union Memorial Hospital, Baltimore, Maryland.
authors: Allison A
authors: AA
authors: Chilipko
authors: MedStar Union Memorial Hospital, Baltimore, Maryland.
authors: Daryn K
authors: DK
authors: Norwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D010820:Physicians / Q000458:organization & administration; D012189:Retrospective Studies; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: AE = Adverse events; AMS = Anticoagulation management service; Afib = Atrial fibrillation; Anticoagulation; CT = Computed tomography; DVT = Deep venous thrombosis; FDA = Food and Drug Administration; FFP = Fresh frozen plasma; Hgb = Hemoglobin; INR = International normalized ratio; International normalized ratio; Joint Commission; NNT = Number needed to treat; NPSG = National Patient Safety Goal; PE = Pulmonary embolism; PI = Performance improvement; PMS = Pharmacokinetics Monitoring Service; Pharmacist; Pharmacokinetics; Scr = Serum creatinine; TTR = Time in therapeutic range; Warfarin