Pharmacist-Managed Oral Anticoagulation Therapy in the Community Setting
Abstract:Pharmacists are at the forefront when caring for patients requiring anticoagulation resulting from chronic conditions, complex medications therapy, or at risk for drug interactions. As a consequence, there is a greater need for pharmacist-managed anticoagulation clinics in the community setting. This article will review special considerations for oral anticoagulant therapy in the elderly, collaborative therapy management, establishment of policies and procedures, documentation of patient visits, patient counseling, and barriers to successful anticoagulation management. It will also discuss evidence-based guidelines for the use of oral anticoagulants and compare the agents currently approved by the Food and Drug Administration. Finally, barriers to anticoagulation management will be examined, including issues with adherence and communication with patients and health care providers.
Keywords: ACCP = American College of Chest Physicians; AF = Atrial fibrillation; Administration; Ambulatory care; Anticoagulation; CV = Cardiovascular; CYP = Cytochrome P450; Clcr = Creatinine clearance; Collaborative drug therapy management; DVT = Deep-vein thrombosis; EMR = Electronic medical record; FDA = Food and Drug Administration; GI = Gastrointestinal; INR = International normalized ratio; LMWH = Low molecular weight heparin; MI = Myocardial infarction; NSAIDs = Nonsteroidal anti-inflammatory drugs; Oral anticoagulants; PCC = Prothrombin complex concentrate; PE = Pulmonary embolism; POCT = Point-of-care testing; PT = Prothrombin time; Pharmacist; Point-of-care testing; SCr = Serum creatinine; THA = Total hip arthroplasty; TIA = Transient ischemic attack; TKA = Total knee arthroplasty; VKORC1 = Vitamin K epoxide reductase complex 1; VTE = Venous thromboembolism; Warfarin; aPTT = Activated partial thromboplastin time; p-gp = p-glycoprotein
Document Type: Research Article
Publication date: 2013-05-01
- The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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