Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy
BackgroundWarfarin is the most common oral anticoagulant drug, especially in low-income and emerging countries, because of the high cost of direct oral anticoagulant (DOACs), or when warfarin is the only proven therapy (mechanical prosthetic valve and kidney dysfunction). The quality of warfarin the...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-07-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphar.2020.01056/full |
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| author | Leiliane Rodrigues Marcatto Luciana Sacilotto Letícia Camargo Tavares Debora Stephanie Pereira Souza Natália Olivetti Celia Maria Cassaro Strunz Francisco Carlos Costa Darrieux Maurício Ibrahim Scanavacca Jose Eduardo Krieger Alexandre Costa Pereira Paulo Caleb Junior Lima Santos |
| author_facet | Leiliane Rodrigues Marcatto Luciana Sacilotto Letícia Camargo Tavares Debora Stephanie Pereira Souza Natália Olivetti Celia Maria Cassaro Strunz Francisco Carlos Costa Darrieux Maurício Ibrahim Scanavacca Jose Eduardo Krieger Alexandre Costa Pereira Paulo Caleb Junior Lima Santos |
| author_sort | Leiliane Rodrigues Marcatto |
| collection | DOAJ |
| description | BackgroundWarfarin is the most common oral anticoagulant drug, especially in low-income and emerging countries, because of the high cost of direct oral anticoagulant (DOACs), or when warfarin is the only proven therapy (mechanical prosthetic valve and kidney dysfunction). The quality of warfarin therapy is directly associated with dose management. Evidence shows that pharmaceutical care achieves a better quality of therapy with warfarin. However, there are no studies showing this intervention in a specific patient group with poor quality of anticoagulation in a long period after the end of the follow-up by a pharmacist. Thus, the aim of this study was to evaluate whether the quality of warfarin therapy driven by a pharmacist remains stable in the long term after the end of follow up with a pharmacist, in AF patients with poor quality of anticoagulation.MethodsThis is a prospective study, which evaluated about 2,620 patients and selected 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR<50% - based on the last three values of international normalized ratio). Pharmacist-driven therapy management was performed up to 12 weeks. Data from patients were evaluated 1 year after the end of the follow-up with pharmacist.ResultsComparison between mean TTR after 12 weeks of pharmaceutical care (54.1%) and mean TTR one year after the end of the pharmaceutical care (56.5%; p=0.081) did not achieve statistical difference, demonstrating that the increment of quality due to intervention of 12 weeks was maintained for 1 year after intervention.ConclusionThe long-term impact of pharmaceutical care was beneficial for patients with AF and poor quality of warfarin anticoagulation. This design might be an important strategy to treat a subgroup of patients without proven effectiveness of warfarin. |
| first_indexed | 2024-12-10T10:25:46Z |
| format | Article |
| id | doaj.art-7fabddf7bf314677add708a3d8eb8427 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-10T10:25:46Z |
| publishDate | 2020-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-7fabddf7bf314677add708a3d8eb84272022-12-22T01:52:43ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122020-07-011110.3389/fphar.2020.01056512633Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation TherapyLeiliane Rodrigues Marcatto0Luciana Sacilotto1Letícia Camargo Tavares2Debora Stephanie Pereira Souza3Natália Olivetti4Celia Maria Cassaro Strunz5Francisco Carlos Costa Darrieux6Maurício Ibrahim Scanavacca7Jose Eduardo Krieger8Alexandre Costa Pereira9Paulo Caleb Junior Lima Santos10Laboratory of Genetics and Molecular Cardiology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilArrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilLaboratory of Genetics and Molecular Cardiology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilDepartment of Pharmacology, Escola Paulista de Medicina, Universidade Federal de São Paulo, EPM-Unifesp, São Paulo, BrazilArrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilClinical Laboratory, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Umiversidade de Sao Paulo, Sao Paulo, BrazilArrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilArrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilLaboratory of Genetics and Molecular Cardiology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilLaboratory of Genetics and Molecular Cardiology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BrazilDepartment of Pharmacology, Escola Paulista de Medicina, Universidade Federal de São Paulo, EPM-Unifesp, São Paulo, BrazilBackgroundWarfarin is the most common oral anticoagulant drug, especially in low-income and emerging countries, because of the high cost of direct oral anticoagulant (DOACs), or when warfarin is the only proven therapy (mechanical prosthetic valve and kidney dysfunction). The quality of warfarin therapy is directly associated with dose management. Evidence shows that pharmaceutical care achieves a better quality of therapy with warfarin. However, there are no studies showing this intervention in a specific patient group with poor quality of anticoagulation in a long period after the end of the follow-up by a pharmacist. Thus, the aim of this study was to evaluate whether the quality of warfarin therapy driven by a pharmacist remains stable in the long term after the end of follow up with a pharmacist, in AF patients with poor quality of anticoagulation.MethodsThis is a prospective study, which evaluated about 2,620 patients and selected 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR<50% - based on the last three values of international normalized ratio). Pharmacist-driven therapy management was performed up to 12 weeks. Data from patients were evaluated 1 year after the end of the follow-up with pharmacist.ResultsComparison between mean TTR after 12 weeks of pharmaceutical care (54.1%) and mean TTR one year after the end of the pharmaceutical care (56.5%; p=0.081) did not achieve statistical difference, demonstrating that the increment of quality due to intervention of 12 weeks was maintained for 1 year after intervention.ConclusionThe long-term impact of pharmaceutical care was beneficial for patients with AF and poor quality of warfarin anticoagulation. This design might be an important strategy to treat a subgroup of patients without proven effectiveness of warfarin.https://www.frontiersin.org/article/10.3389/fphar.2020.01056/fullanticoagulationwarfarinpharmacistpharmaceutical caretime in the therapeutic range |
| spellingShingle | Leiliane Rodrigues Marcatto Luciana Sacilotto Letícia Camargo Tavares Debora Stephanie Pereira Souza Natália Olivetti Celia Maria Cassaro Strunz Francisco Carlos Costa Darrieux Maurício Ibrahim Scanavacca Jose Eduardo Krieger Alexandre Costa Pereira Paulo Caleb Junior Lima Santos Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy Frontiers in Pharmacology anticoagulation warfarin pharmacist pharmaceutical care time in the therapeutic range |
| title | Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy |
| title_full | Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy |
| title_fullStr | Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy |
| title_full_unstemmed | Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy |
| title_short | Evaluation of the Long-Term Impact on Quality After the End of Pharmacist-Driven Warfarin Therapy Management in Patients With Poor Quality of Anticoagulation Therapy |
| title_sort | evaluation of the long term impact on quality after the end of pharmacist driven warfarin therapy management in patients with poor quality of anticoagulation therapy |
| topic | anticoagulation warfarin pharmacist pharmaceutical care time in the therapeutic range |
| url | https://www.frontiersin.org/article/10.3389/fphar.2020.01056/full |
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