A ผลสัมฤทธิ์ทางคลินิกจากการดำเนินงานการบริบาลทางเภสัชกรรมร่วมกับทีมสหสาขาวิชาชีพ ในผู้ป่วยที่ได้รับยาวาร์ฟาริน โรงพยาบาลพระนครศรีอยุธยา Clinical Outcomes of Pharmaceutical Care in Collaboration with A multidisciplinary Team for Patients Receiving Warfarin at Ayutthaya Hospital

Abstract

Objective: To determine clinical outcomes and its associating factors of implementation of pharmaceutical care in patients receiving warfarin at Ayutthaya Hospital, Thailand. Method: Data were retrospectively collected from an electronic database spanning from 2002 to 2017 (i.e., duration with warfarin pharmaceutical care) using ICD-10 codes. The data included age, deaths, hospital readmissions, INR and comorbidities. Data were summarized using mean with standard deviation and frequency with percentage. Associations were tested using chi-square test. Results: Of 1,867 patients, 53.4% were women. Their average age was 63.84 years. The majority used warfarin for atrial fibrillation (53.13%). Mean duration of warfarin use was 2.17 years. For primary outcomes, death due to major bleeding or major thromboembolism was 3.42%. Fr secondary outcomes, the incidences of re-hospitalization from major bleeding and major thromboembolism were 1.61% and 7.87%, respectively. Death from any cause was 14.38%. Within-therapeutic INRs during 2013 and 2017 were 34.39% to 38.54% respectively. Most INRs were below 2. 0. Age of 75 years or older was significantly correlated with death from major thromboembolism (P-value < 0.05). Conclusion: Death from severe bleeding and severe thrombosis in patient using warfarin who received pharmaceutical care was 3.42%. Proportions of within-therapeutics range INRs increased. Risk of death from due to severe thrombosis increased with older age. Keyword: warfarin; pharmaceutical care; clinical outcomes; major bleeding; major thromboembolism