Abstract

STUDY OF IMPACT OF CLINICAL PHARMACIST’S INTERVENTIONS ON INR MONITORING IN PATIENTS WITH WARFARIN THERAPY

Pragathi Reddy Gunnam*, Divya Satyanarayana, Meghana Tummalapalli, Richa Srivastava, Dr. Anand Agarwal

ABSTRACT

Background: Patients with mechanical valve replacement require lifelong anticoagulation therapy with warfarin but warfarin has a very narrow therapeutic index, INR below the therapeutic range (< 2) causes clotting while above the range (> 3) results in bleeding. Therefore it requires close monitoring for patients with warfarin therapy. An adequate knowledge and importance of warfarin therapy among patients is essential for effective outcomes of warfarin therapy. The objective of this study was to determine the impact of clinical pharmacist‟s intervention on INR monitoring between patients who were and were not provided with the pharmacist‟s interventions respectively. Methods: Patients were divided into 2 groups of 35 each. One group was selected before the establishment of anticoagulation management services and hence such patient group were not exposed to patient counselling. The other group consisted of patients after the establishment of anticoagulation management services. Percentage of INR monitoring and deviations in INR ranges of individuals were assessed. SPSS version 20 and INSTAT software were used for data analysis .Unpaired „t‟test was used for data analysis. Results: Contingency table drawn between patients exposed to and unexposed to pharmacist‟s interventions (ie patient counseling) showed that INR monitoring has improved from 34.3% in individuals unexposed to pharmacist‟s interventions to 82.9% in individuals exposed to interventions( ie in counselled group ). Unpaired „t‟ test between quartile deviations of INR values showed a significant difference between individuals exposed to and unexposed to clinical pharmacist‟s interventions. Conclusion: This study showed the impact of clinical pharmacist‟s interventions in patients on warfarin therapy both on improvement of INR monitoring as well as reductions in the deviations of INR ranges in patients intervened. This proves that adequate knowledge about warfarin therapy in patients is essential for effective outcomes of therapy

Keywords: warfain, INR, clinical pharmacist, interventions.