Management of Chinese patients on warfarin therapy in two models of anticoagulation service – a prospective randomized trial
- 26 May 2006
- journal article
- research article
- Published by Wiley in British Journal of Clinical Pharmacology
- Vol. 62 (5), 601-609
- https://doi.org/10.1111/j.1365-2125.2006.02693.x
Abstract
To compare the treatment outcomes of a clinical pharmacist-managed anticoagulation service with physician-managed service in Chinese patients. A prospective, randomized clinical trial was conducted at the anticoagulation clinic of a teaching hospital in Hong Kong. Patients aged > or = 18 years who would required warfarin therapy for at least 3 months were recruited. Patients were randomized to the pharmacist-managed or physician-managed group. Primary clinical outcome was assessed by the percentage of patient time spent within the target international normalized ratio (INR) range. The incidence of major thromboembolic events (TEs) and major bleeding was assessed as secondary clinical outcomes. The cost per patient per month (cPPPM) was calculated and patient satisfaction was assessed by patient satisfaction questionnaire (PSQ)-18. One hundred and forty-one patients were recruited at the anticoagulation clinic and 137 patients completed the study. Patients in the pharmacist-managed group (n = 68) were in the target INR 64% of patient time vs. 59% in the physician-managed group (n = 69) (P < 0.001). There was no significant difference in incidence of major TEs or bleeding. The cPPPM in the pharmacist-managed group (76 +/- 95 US dollar) (43 +/- 53 British pound) was lower than in the physician-managed group (98 +/- 158 US dollar) (55 +/- 89 British pound) (P < 0.001). The PSQ-18 score of the pharmacist-managed group (3.8 +/- 0.2) was higher than that of the physician-managed group (3.6 +/- 0.3) (P < 0.001). The pharmacist-managed anticoagulation service was more effective and less costly than the physician-managed service in achieving target anticoagulation control for Chinese patients on warfarin therapy.Keywords
This publication has 24 references indexed in Scilit:
- Association of Vitamin K epoxide reductase complex 1 (VKORC1) variants with warfarin dose in a Hong Kong Chinese patient populationPharmacogenetics and Genomics, 2005
- Effect ofVKORC1Haplotypes on Transcriptional Regulation and Warfarin DoseNew England Journal of Medicine, 2005
- A novel functional VKORC1 promoter polymorphism is associated with inter-individual and inter-ethnic differences in warfarin sensitivityHuman Molecular Genetics, 2005
- Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate‐intensity anticoagulation?British Journal of Clinical Pharmacology, 2005
- Accuracy and Precision of the CoaguChek S versus Laboratory INRs in a ClinicAnnals of Pharmacotherapy, 2002
- The cost-effectiveness of different management strategies for patients on chronic warfarin therapyJournal of General Internal Medicine, 2000
- Comparison of an Anticoagulation Clinic With Usual Medical CareArchives of Internal Medicine, 1998
- Evolving models of warfarin management: Anticoagulation clinics, patient self-monitoring, and patient self-managementAmerican Heart Journal, 1996
- Factors determining the maintenance dose of warfarin in Chinese patientsQJM: An International Journal of Medicine, 1996
- Risk Factors for Complications of Chronic Anticoagulation: A Multicenter StudyAnnals of Internal Medicine, 1993