IMPACT OF PHARMACIST LED ANTICOAGULATION MONITORING AND PATIENT EDUCATION ON ORAL ANTICOAGULATION THERAPY WITH ACENOCOUMAROL

  • Poojitha Reddy CHEDEPUDI Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
  • Omsri Mounika Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
  • Gaddam Chandrika Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
  • Aldrich Franklin Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
  • Ramesh M Department of Accident & Emergency Medicine, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
  • Vanitha Rani N Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
  • Thennarasu P Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India

Abstract

 

 Objective: Acenocoumarol is anoral anticoagulant with narrow therapeutic index, and the ideal dose of anticoagulation lies between International normalized ratio (INR) values of 2.0 and 3.5. Lack of monitoring and knowledge on acenocoumarol therapy may compromise patient's safety resulting in under- or over-anticoagulation. A study was conducted to monitor for the safety of anticoagulation therapy, achievement of goal INR levels and to assess the impact of pharmacist led anticoagulation monitoring and patient education on the rational use of acenocoumarol in patients admitted in cardiology wards with thromboembolic disorders.

Methods: The study was conducted in 70 patients; data collection was done, prescriptions were analyzed for drug-drug interactions and adverse drug reactions (ADRs). Patients' knowledge on acenocoumarol therapy was assessed using a self-developed questionnaire at the baseline, then were subjected to a detailed patient education and on an average each patient received three sessions of education. They were again made to answer the same questionnaire on the day of discharge. The mean score of the responses before and after education was compared statistically using Wilcoxon signed rank test and McNemar test.

Results: There were 60% patients under anticoagulated with the INR range of >2.0. 123 drug interactions were observed in 58 patients, on an average of 2 interactions per prescription, but no ADRs were observed. 59 patients (84.3%) showed significant overall improvement in knowledge on anticoagulation therapy following education.

Conclusion: This study implies the role of clinical pharmacists in achieving better clinical outcomes in patients receiving oral anticoagulation therapy with acenocoumarol.

Keywords: Acenocoumarol, Anticoagulation, Patient education.

Author Biography

Ramesh M, Department of Accident & Emergency Medicine, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India

Department of Pharmacy Practice

 

References

1. Militaru FC, Crisan S, Veda SC, Trifa A, Militaru V, Buzoianu AD. Determinants of hemorrhagic risk during acenocoumarol treatment. Hum Vet Med Int J Bioflux Soc 2012;4(1):23-7.
2. Barcelona D, Vannini ML, Fen L, Balestrieri C, Marongiu F. Warfarin or acenocoumarol: Which is better in the management of oral anticoagulants? Thromb Haemost Schattauer Verlag Stuttgart 1988;80:899-902.
3. Pharmacology of Acenocoumarol. Available from: http://www.uptodate.com/contents/acenocoumarol-drug-information?source=search_result&search= Acenocoumarol&selectedTitle=1~15. [Last cited on 2015 Feb 19].
4. Information about Acenocoumarol. Available from: http://www.patent.co.uk/medicine/Acenocoumarol.html. [Last cited on 2015 Feb 19].
5. Indications of Acenocoumarol. Available from: http://www.medindia.net/doctors/drug_information/acenocoumarol.htm. [Last cited on 2015 Mar 07].
6. Use of Acenocoumarol. Available from: http://www.old.health.gov.il/units/pharmacy/trufot/alonim/4140.pdf. [Last cited on 2015 Mar 07].
7. WeMeReC, Welsh Medicines Resource Centre. Canolfan Adnoddau Moddion Cymru). Monitoring Anticoagulant Therapy in Primary Care. Bulletin ‘Independent Prescribing Information for NHS Wales’. March, 2007. Penarth: WeMeReC; 2017. p. 1-6.
8. Hosmane SR, Tucker J, Osman D, Williams S, Waterworth P. Inpatient oral anticoagulation management by clinical pharmacists: Safety and cost effectiveness. J Clin Med Res 2010;2(2):90-2.
9. Young S, Bishop L, Tells L, Dillon C, Hawboldt J, O’Shea P. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic. BMC Fam Pract 2011;12:88.
10. Drug-Drug Interactions with Acenocoumarol. Available from: http://www.uptodate.com/home/drugs-drug-interaction. [Last cited on 2015 Mar 12].
11. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30(2):239-45.
12. Classification of Educational Status and Socio-Economic Status. Available from: http://www.medind.nic.in/ibv/t09/i12/ibvt09i12p1104.pdf. [Last cited on 2015 Mar 10].
13. Tang EO, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. Relationship between patient’s warfarin knowledge and anticoagulation control. Ann Pharmacother 2003;37:34-9.
14. Lakshmi R, James E, Kirthivasan R. Study on impact of clinical pharmacist’s interventions in the optimal use of oral anticoagulants in stroke patients. Indian J Pharm Sci 2013;75(1):53-9.
15. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: Anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998;158(15):1641-7.
16. Andhuvan G, Venkatachalam VV, Sankar V. Impact of pharmacist education on medication adherence in heart failure patients. Int J Pharm Pharm Sci 2014;6(11):474-6.
17. Rana I, Saber-Ayad M. Continuous outpatient warfarin counseling and its effects on adherence. Asian J Pharm Clin Res 2013;6(2):101-104.
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CHEDEPUDI, P. R., O. Mounika, G. Chandrika, A. Franklin, R. M, V. Rani N, and T. P. “IMPACT OF PHARMACIST LED ANTICOAGULATION MONITORING AND PATIENT EDUCATION ON ORAL ANTICOAGULATION THERAPY WITH ACENOCOUMAROL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 10, no. 10, Sept. 2017, pp. 314-7, doi:10.22159/ajpcr.2017.v10i10.16459.
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