title: Survey of pharmacists' subtherapeutic INR management and anticoagulation bridging practices.
abstract: OBJECTIVE
  Despite extensive warfarin use, optimal management of subtherapeutic international normalized ratios (INRs) remains unclear. This study assessed the differences in bridging practices among pharmacists with varying levels of experience, residency training and prescribing privileges.
  
  
  METHODS
  An electronic survey was distributed to two ambulatory care pharmacist e-mail lists. Respondents indicated if they would utilize parenteral anticoagulation bridging in 16 clinical scenarios at three therapeutic time points. The scenarios included patients with atrial fibrillation (AFib) (CHADS2score of 3-4), AFib (CHADS2score of 5-6) and venous thromboembolism (VTE). The AFib time points were as follows: anticoagulation initiation, early phase (<1 month) and maintenance phase (>1 month). VTE time points included early phase (<1 month), months 2-3 and maintenance phase (>3 months).
  
  
  CONCLUSIONS
  The survey was completed by 143 respondents. In only three of the scenarios did >50% of respondents indicate they would utilize parenteral anticoagulation bridging. No statistically significant differences in bridging practices were identified between pharmacists providing anticoagulation services in different clinic settings. However, there were significant differences in bridging practices between pharmacists with varying levels of experience, residency training and prescribing privileges in some, but not all of the scenarios.
  
  
  CONCLUSIONS
  The standards of care for subtherapeutic INRs warrant further definition.
authors.affiliation: Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy - USC Campus, Columbia, SC, USA.
authors.forename: W D
authors.initials: WD
authors.lastname: Maxwell
authors.affiliation: Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Shrader
authors.affiliation: Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Moore
authors.affiliation: Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy - USC Campus, Columbia, SC, USA.
authors.forename: Z K
authors.initials: ZK
authors.lastname: Lu
authors.affiliation: Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: S F
authors.initials: SF
authors.lastname: White
keywords: anticoagulation; bridge therapy; clinical pharmacy; low molecular weight heparin; warfarin