Anticoagulant services

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Clinical pharmacy input into anticoagulant therapy is now a widely accepted part of clinical practice in many hospitals.

Anticoagulant services


Clinical pharmacy input into anticoagulant therapy is now a widely accepted part of clinical practice in many hospitals. Some anticoagulant services were initially set up as collaborative ventures with medical staff, but pharmacists now manage many services. Although the exact nature of services provided by the pharmacist may vary slightly from hospital to hospital, the role of the pharmacist in anticoagulation has been clearly established: (1) ensuring complete documentation and referral information is present; (2) interviewing patients and assessing factors that may affect anticoagulant control, particularly disease states and drug interactions; (3) monitoring and adjusting anticoagulant doses to maintain the international normalised ratio within agreed therapeutic targets; (4) identifying clinical problems that require referral to a physician; (5) patient counselling and education; (6) providing a regular point of contact for patients with concerns about their treatment; (7) day-to-day clinic management training and education for physicians and pharmacists; and (8) research and audit. Clinical pharmacists can provide high-quality cost-effective anticoagulant services for both hospital inpatients and outpatients. Evaluations of services provided show that pharmacist anticoagulant control is at least as good as, and in some cases better than, that achieved by medical staff. However, the introduction of new oral antithrombin and Xa inhibitors, which do not require the same level of laboratory monitoring, are increasingly likely to offer a viable alternative to these traditional anticoagulant services.


In more recent years, the use of anticoagulants for prevention of venous thromboembolism (VTE) has become much more important as the risks to patients have become better recognised. NICE published a clinical guideline on VTE across all adult specialties in January 2010. In England, from April 2010, the national Commission for Quality and Innovation payment frame-work includes reducing avoidable death, disability and chronic ill health from VTE as one of two national goals. These documents seek to ensure that appropriate risk assessments have been carried out on admission to hospital so that patients can be identified for thromboprophylaxis, and mechanical measures, where necessary. This is not restricted to those involved in anticoagulant services and so clinical pharmacists from all disciplines will play a significant part in ensuring compliance with the national guidance. The particular contribution that pharmacy can make is set out in Venous Thromboembolism Prevention, a Patient Safety Priority, published by the Department of Health along with the All-Party Parliamentary Thrombosis Group.


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