Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction: Patients with LVADs face an increased risk of thrombotic and bleeding events, so anticoagulation therapy with warfarin must be managed carefully. Studies have showcased higher proportion of time within therapeutic INR range with the incorporation of pharmacists in an LVAD clinic over shorter study durations. Our study focused on patients who received HeartMate 3 (HM3) devices, evaluating outcomes over 6 months prior to and after the implementation of independent pharmacist dosing.
Research Question or Hypothesis: Did pharmacist-led warfarin dosing achieve similar time in therapeutic range (TTR) compared to dosing approved by physicians in outpatient HM3 LVAD patients?
Study Design: A retrospective chart review of HM3 LVAD patients were examined for INR levels and occurrences of gastrointestinal bleeding that resulted in hospital admissions.
Methods: A retrospective chart review of 127 patients was conducted to assess time in therapeutic INR range for patients pre- and post- initiation of pharmacist-managed warfarin dosing in an outpatient LVAD Clinic. HM3 LVAD patients implanted before September 2022 with no bleeding or thrombosis in the past 6 months were included in the analysis. The primary outcome was time in therapeutic INR range 6 months pre- and 6 months post- pharmacist warfarin dosing implementation. Secondary outcomes include occurrence of INRs < 1.5 and > 4, number of INRs drawn per patient, and number of bleeding episodes.
Results: Pharmacist managed warfarin dosing led to an overall improvement in TTR for HM3 patients, though the increase was not statistically significant. TTR was 57% with physician-approved warfarin dosing and 62% with pharmacist independent dosing (p=0.23). The occurrence of INR < 1.5 or > 4 was similar in both groups, as were average number of INRs drawn per patient and number of bleeding episodes.
Conclusion: Pharmacist-led warfarin dosing achieved similar TTR to dosing approved by physicians in outpatient HM3 LVAD patients.
Presenting Author
Emina Halimanovic PharmDMedStar Washington Hospital Center
Authors
Sharika Johnson PharmD
MedStar Washington Hospital Center
Lisa Peters PharmD
MedStar Washington Hospital Center