The Establishment Of Anticoagulation Management Mode With Warfarin And Its Clinical Effects

Objective:This study attempted to develop inpatient anticoagulation service by clinical pharmacists,and to evaluate its effect.Due to our country has not established a standard anticoagulant management model,then it could offer the positive reference for pharmaceutical care path.Method:According to the inclusion and exclusion criteria,hospitalization patients who took warfarin from November 2016 to November 2017 in the First Affiliated Hospital of Kunming Medical University and continued to use the medicine for 3 months outside the hospital were selected as research subjects.All subjects were divided into two groups.Patients admitted from November 2016 to May 2017 as control group,only received traditional medical treatment and no pharmaceutical care.Patients admitted from June 2017 to November 2017 served as management group,and their anticoagulant management was carried out by clinical pharmacists on the basis of doctors' treatment.Through the standardization of work processes,the warfarin anticoagulation management model is mainly divided into two phases:the first is the pharmaceutical care during hospitalization,and the second is Pharmacist follow-up.According to the different services in different stages,the pharmaceutical care effect on anticoagulant efficacy,safety and compliance were evaluated.Results:In this study,162 patients were selected,including 80 cases in the control group and 82 cases in the management group.16 cases being withdrawn and 146 cases completed the follow-up,among which 70 cases in the control group and 76 cases in the management group.1.Evaluation of anticoagulant efficacy:Compared with the control group,there was no significant difference in the INR standard-reaching rate of the management group in the beginning(p>0.05),while the rate greatly increased when discharged(p<0.05),and the TTR qualified rate was improved(p<0.05).2.Evaluation of anticoagulant safety:Compared with the control group,the incidence of adverse events during hospitalization and out-of-hospital was significantly reduced in the management group(p<0.05).3.Evaluation of adherence to anticoagulant therapy:The anticoagulant recognition of both groups were enhanced greatly after education(p<0.05),compared with the control group,that of the management group was promoted(p<0.05).More patients expressed "very satisfied" with medication guidance in the management(p<0.05),and the adherence obviously increased at the 3rd month after discharge(p<0.05).Conclusion:Taking pharmacists-oriented anticoagulation management and forming a systematic pharmaceutical care,that including standardized monitoring,service processes,and follow-up care,it plays a key role to improve the efficacy and compliance of anticoagulant therapy in patients,and reduce the occurrence of adverse events.Furthermore,it will contribute to anticoagulation management path making.