Clinical pharmacist-managed anticoagulation service in atrial fibrillation patients: an Egyptian experience

Clinical pharmacist-managed anticoagulation service in atrial fibrillation patients: an Egyptian experience

Sarah Sabry, B.Sc. ¹, Lamia Mohamed El Wakeel, Ph.D. ², Mohamed Ayman Saleh, M.D. ³

(1) The Cardiovascular Hospital, Ain Shams University, Cairo, Egypt; (2) Department of Clinical Pharmacy, Ain Shams University, Cairo, Egypt; (3) Department of Cardiology, Ain Shams University, Cairo, Egypt.

Introduction: Managing warfarin administration is challenging due to its narrow therapeutic index, multiple food and drug interactions and frequent INR monitoring.

Objectives: This study evaluated the impact of clinical pharmacist-provided anticoagulation management on; anticoagulation management, incidence of bleeding and thromboembolic events, incidence of warfarin drug and food interactions and subjective anticoagulation knowledge assessment.

Study Design: Prospective, randomized controlled study.

Methods: All newly diagnosed non-valvular AF patients receiving warfarin were assessed for eligibility. Eligible patients were randomly assigned to either group A (intervention group, n=30); AF patients received clinical pharmacist-managed anticoagulation service, or group B (Control group, n=30); patients received routine medical care. Informed consents were obtained from all patients. At baseline, all collected data (demographics, INR and subjective anticoagulation knowledge assessment questionnaire (AKA score) were comparable between both groups. After 6 months of evaluation, the principal outcomes were percentage time spent in therapeutic INR range (TTR %), bleeding or thromboembolic events incidence, warfarin-drug and warfarin-food interactions incidence and AKA score.

Results: At the end of study, the intervention group versus control group, showed a significantly higher TTR% (68 ± 8 versus 38 ± 11, p <0.001), a lower incidence of bleeding events (p <0.001), a lower incidence of warfarin-drug interactions (p <0.001) and a higher AKA score (21 ± 2.4 versus 10.4 ± 3, p <0.001).

Conclusions: Clinical pharmacist-provided anticoagulation management of Egyptian AF patients improved patients' percentage TTR, levels of anticoagulation knowledge and practice and provided a lesser frequency of bleeding events and warfarin-drug interactions. 

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