Outcome Analysis of Anticoagulant Therapy in Critical Care Unit: The Need for a Pharmacy Managed Anticoagulant Service

Nwafor IA¹*, Nwafor MN², Gbenimachor MN², Onodugo CI², Anakwe RC³ and Nwagha TU⁴

Received: March 13, 2019;   Published: March 22, 2019

DOI: 10.32474/ACR.2018.01.000126

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Abstract

Background: In our center, NCTCE, there are 2 intensive care units (general and cardiac), where critically ill patients are admitted and managed. Anticoagulation is usually indicated in such patients for atrial fibrillation, valve replacement and DVT prophylaxis.

Objective: To determine the role of a clinical pharmacist in the therapeutic and clinical appraisal of such patients on anticoagulation.

Materials and Method: Over a 2-year period (June 2015 –May 2017), a study design to determine the role of a clinical pharmacist in anticoagulant treatment was made in both ICU. This was a prospective longitudinal study. Here, demography, the anticoagulation on which interventions were made on, duration of admission, areas and determinants of a clinical pharmacist’s interventions were incorporated. Others included, were levels of intervention, acceptance and rejection of the interventions as well as the outcome.

Results: During the study period, 168 patients were used. Male (72) and female (96), with a female to male ratio of 1:1.3. Indications for anticoagulation were DVT prophylaxis (14.88%), valves (83.90%) and AF (1.10%). Among the anticoagulants on which interventions were made on, warfarin was the highest (53.57%) while heparin was the least (2.90%). Duration of admission ranged from 2-40 days. Areas of intervention were on effectiveness of therapy (18.70%), drug-drug interactions (16.43%), adverse events (32.86%), dosage (11.05%), Kidney function (1.70%), adherence (6.70%) and drug selection (2.27%). Levels of intervention were at prescriber (30.51%), drug (38.56%), patient (25.42%) and laboratory (5.51%). The outcome was that majority of patients (78.74%) had their problems resolved.

Conclusion: Anticoagulation therapy of patients in ICU requires precise damaging, monitoring and appropriate patient education so as to ensure that patients benefit maximally. A clinical pharmacist has a vital role to play in the above areas.

Abbreviations: ICU: Intensive Care unit; PhRs: Pharmacist Recommendations; INR: International Normalized Ratio; ACCP: American Critical Care Physician; ADES: Adverse Events; VTE: Venous Thromboembolism; DTPS: Drug Therapies; DDI/DFI: Drug Drug/Dug Food Interactions; LMWH: Low Molecular Weight Heparins; CVP: Central Venous Pressure; CHADS: Congestive Heart failure, Hypertension, Age, Diabetes, Stoke

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