Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin

Author(s):Show less -

Marcatto, Leiliane Rodrigues ^[1] ; Sacilotto, Luciana ^[2] ; Tavares, Leticia Camargo ^[1] ; Facin, Mirella ^[2] ; Olivetti, Natalia ^[2] ; Cassaro Strunz, Celia Maria ^[3] ; Costa Darrieux, Francisco Carlos ^[2] ; Scanavacca, Mauricio Ibrahim ^[2] ; Krieger, Jose Eduardo ^[1] ; Pereira, Alexandre Costa ^[1] ; Junior Lima Santos, Paulo Caleb ^{[4, 1]}

Affiliation

^[1] Univ Sao Paulo, Heart Inst InCor, Lab Genet & Mol Cardiol, Fac Med FMUSP, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med FMUSP, Arrythmia Unit, Heart Inst InCor, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med FMUSP, Heart Inst InCor, Clin Lab, Sao Paulo - Brazil

^[4] Univ Fed Sao Paulo, Dept Pharmacol, Escola Paulista Med, Sao Paulo - Brazil

• Document type: Journal article
• Source: FRONTIERS IN PHARMACOLOGY; v. 9, SEP 21 2018.
• Web of Science Citations: 1

Abstract

Thromboembolic events are associated with high mortality and morbidity indexes. In this context, warfarin is the most widely prescribed oral anticoagulant agent for preventing and treating these events. This medication has a narrow therapeutic range and, consequently, patients usually have difficulty in achieving and maintaining stable target therapeutics. Some studies on the literature about oral anticoagulant management showed that pharmacists could improve the efficiency of anticoagulant therapy. However, the majority of these studies included general patients retrospectively. The aim of this study was to prospectively evaluate a pharmacist's warfarin management in patients with poor quality of anticoagulation therapy (Time in the Therapeutic Range-TTR < 50%). We included 268 patients with atrial fibrillation (AF) and without stable dose of warfarin (TTR < 50%, based on the last three values of International Normalized Ratio-INR). We followed them up for 12 weeks, INR values were evaluated and, when necessary, the dose adjustments were performed. During the first four visits, patient's INR was measured every 7 days. Then, if INR was within the target therapeutic range (INR: 2-3), the patient was asked to return in 30 days. However, if INR was out the therapeutic target, the patient was asked to return in 7 days. Adherence evaluation was measured through questionnaires and by counting the pills taken. Comparison between basal TTR (which was calculated based on the three last INR values before prospective phase) and TTR of 4 weeks (calculated by considering the INR tests from visits 0 to 4, in the prospective phase of the study) and basal TTR and TTR of 12 weeks (calculated based on the INR tests from visits 0 to 12, in the prospective phase of the study) revealed significant statistical differences (0.144 +/- 0.010 vs. 0.382 +/- 0.016; and 0.144 +/- 0.010 vs. 0.543 +/- 0.014, p < 0.001, respectively). We also observed that the mean TTR of 1 year before (retrospective phase) was lower than TTR value after 12 weeks of pharmacist-driven treatment (prospective phase) (0.320 +/- 0.015; 0.540 +/- 0.015, p < 0.001). In conclusion, pharmaceutical care was able to improve TTR values in patients with AF and poor quality of anticoagulation with warfarin. (AU)

• FAPESP's process: 16/23454-5 - Evaluation of a pharmacogenetic-based warfarin dosing algorithm in patients without stable dose
• Grantee: Leiliane Rodrigues Marcatto
• Support Opportunities: Scholarships in Brazil - Doctorate
• FAPESP's process: 13/09295-3 - Pharmacogenetic of cardiovascular system drugs focusing on implementation
• Grantee: Paulo Caleb Júnior de Lima Santos
• Support Opportunities: Research Grants - Young Investigators Grants