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