Clinical impact of temporary therapy interruptions on anticoagulation control in patients treated with warfarin.
Female; Male; Aged; Prospective Studies; International Normalized Ratio; Drug Administration Schedule; Preoperative Care; Postoperative Care; Human; Middle Age; Retrospective Design; Dose-Response Relationship; Drug; Treatment Outcomes; Drug Monitoring; Anticoagulants – Therapeutic Use; Anticoagulants – Administration and Dosage; Atrial Fibrillation – Drug Therapy; Blood Coagulation Disorders – Drug Therapy; Coronary Thrombosis – Drug Therapy; Euthanasia; Passive; Venous Thromboembolism – Drug Therapy; Warfarin – Administration and Dosage; Warfarin – Therapeutic Use
This retrospective cohort study was completed to describe the impact of short-term therapy interruptions on anticoagulation control in patients receiving warfarin. Patients seen in a pharmacist-managed anticoagulation clinic were included if they were on a stable warfarin dose and then underwent a planned interruption in therapy. Patients were excluded if phytonadione was administered before the interruption or if medications known to interact with warfarin were altered during the interruption. Data were analyzed for 2 groups: (1) patients with a single interruption in therapy (group 1) and (2) patients with a single interruption in therapy plus patients with an extended interruption in therapy (group 2). The primary endpoint was the change in weekly maintenance warfarin dose from preinterruption to postinterruption. Evaluation of 199 patients resulted in 31 interruptions in group 1 and 34 interruptions in group 2. A change in dose was required in 58% of patients in group 1 and 56% of patients in group 2. The mean absolute change in dose was 2.03 ± 2.79 mg (P \textless 0.003) in group 1 and 1.96 ± 2.72 mg (P \textless 0.002) in group 2. For the majority of patients, the dose change represented \textless10% of their preinterruption weekly dose. Of patients requiring a dose change, 50% required an increase in dose. In conclusion, close follow-up is warranted after a warfarin therapy interruption as dose adjustments will likely be needed to regain anticoagulation control and the direction of this dose change cannot be predicted.
Boros Melanie L; Rybarczyk Amy M; Gallegos Patrick J; Zimmerman Jacob P
American Journal of Therapeutics
2013
2013-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e31824ea644" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e31824ea644</a>
Evaluation of factors associated with achieving glycemic control in a pharmacist-managed diabetes clinic.
Ambulatory Care; Ambulatory Care/organization & administration; Blood Glucose – Drug Effects; Blood Glucose/drug effects; Diabetes Mellitus; Dose-Response Relationship; Drug; Female; Follow-Up Studies; Glycated Hemoglobin A/metabolism; Glycosylated – Metabolism; Hemoglobin A; Human; Humans; Hypoglycemic Agents – Administration and Dosage; Hypoglycemic Agents – Therapeutic Use; Hypoglycemic Agents/administration & dosage/*therapeutic use; Insulin – Administration and Dosage; Insulin – Therapeutic Use; Insulin/administration & dosage/therapeutic use; Male; Middle Age; Middle Aged; Pharmaceutical Services/*organization & administration; Pharmacists – Administration; Pharmacists/*organization & administration; Pharmacy Service – Administration; Prospective Studies; Retrospective Design; Retrospective Studies; Social Work – Statistics and Numerical Data; Social Work/statistics & numerical data; Treatment Outcome; Treatment Outcomes; Type 2 – Drug Therapy; Type 2/*drug therapy
The aim of this study was to identify factors that are associated with patients achieving goal A1c after 6 months in a pharmacist-managed diabetes clinic. This study is a descriptive, retrospective chart review of patients with type 2 diabetes enrolled in a pharmacist-managed diabetes clinic. The primary endpoint was the odds of each identified factor being associated with achievement of goal A1c after 6 months of enrollment. The factors were also evaluated within 2 subgroups: those with a baseline A1c \textgreater7% and those with a baseline A1c \textgreater9%. Of 112 patients enrolled, 58 were included in the analysis. There was a positive association with reaching goal for patients who had \textless1 failure to show (FTS) to office visits in 6 months [odds ratio (OR) 8.10, 95% confidence interval (CI) 1.47-58.65], had canceled or FTS to \textless50% of office visits (OR 10.0, 95% CI 1.8-72.79), and brought \textgreater75% of blood glucose logs to their office visits (OR 7.36, 95% CI 1.87-30.88). There was a negative association with reaching the goal for patients with documented social worker involvement (OR 0.22, 95% CI 0.04-0.99) and noninsulin or insulin dose increases at \textgreater50% of office visits (OR 0.10, 95% CI 0.01-0.55). Overall, this analysis found that patients who had \textless1 FTS, had canceled or FTS to \textless50% of office visits, or who brought \textgreater75% logs to office visits were more likely to achieve goal A1c, whereas patients with social work assistance or dose increases at \textgreater50% of office visits were less likely to reach goal A1c.
Kostoff Matthew D; Boros Melanie L; Moorman John M; Frazee Lawrence A
American Journal of Therapeutics
2014
2014-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e31826fc47e" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e31826fc47e</a>