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Outcomes of warfarin therapy managed by pharmacists via hospital anticoagulation clinic versus online anticoagulation clinic

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Abstract

Background In response to the recognized difficulty in the management of patients on anticoagulation therapy, anticoagulation management services were developed in both hospital anticoagulation clinics (HACs) and an online anticoagulation clinic (OAC) by a pharmacist. Objective To compare monitoring outcomes and complications of warfarin therapy managed by pharmacists via hospital or on-line. Setting The anticoagulation clinic of Fujian Medical University Union Hospital, China. Method A retrospective, observational cohort study was used to compare patients managed via hospital  to those managed o-line between December 2015 and 2016. The primary outcome was the percentage of time in the therapeutic range (TTR). The secondary outcomes were the incidence rates of hemorrhagic events, thrombotic events and extreme international normalized ratio (INR) values. Results A total of 152 patients were evaluated; 70 patients managed in a HAC were compared to 82 patients managed via an OAC. There were no significant differences in the TTR (78.9 vs. 74.0%, P = 0.393) and adverse events [major bleeding events (0 vs. 1.2%, P = 1.000), minor bleeding events (10.0 vs. 9.8%, P = 0.960), thromboembolic events (0 vs. 0%, P = 1.000), warfarin-related emergency visits (2.9 vs. 3.7%, P = 1.000)], warfarin-related hospital admissions (0 vs. 1.2%, P = 1.000), and the incidence of subtherapeutic (3.0 vs. 3.8%, P = 0.148), and extreme total (8.4 vs. 5.8%, P = 0.135), between the groups managed via HAC and OAC. Patients managed in the HAC were more stable on warfarin, with a higher percentage of INR values within the target therapeutic range (80.2 vs. 71.9%, P = 0.005) and a lower incidence of supratherapeutic INR values (8.4 vs. 18.5%, P = 0.001) compared to patients managed via OAC. Conclusion The management of oral anticoagulation therapy on-line yielded similar clinical outcomes compared to that achieved by management via the hospital, although the incidence of supra-therapeutic INR values was increased.

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Acknowledgements

We would like to thank Wang CH for helpful comments.

Funding

This research was funded by the Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry [Grant Number: 2015B001]; the Fujian Medical Innovation Project [Grant Number: 2014-CX-18] and the Natural Science Foundation of Fujian Province of China [Grant Number: 2015Y0020].

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Authors and Affiliations

  1. Fujian Medical University Union Hospital, Fuzhou, China

    Hua Cao, Jianmei Wu & Jinhua Zhang

  2. Fujian Provincial Maternity And Child Health Hospital, Fuzhou, China

    Hua Cao

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  1. Hua Cao
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  2. Jianmei Wu
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Correspondence to Jinhua Zhang.

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Cao, H., Wu, J. & Zhang, J. Outcomes of warfarin therapy managed by pharmacists via hospital anticoagulation clinic versus online anticoagulation clinic. Int J Clin Pharm 40, 1072–1077 (2018). https://doi.org/10.1007/s11096-018-0674-0

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