A systematic review on comparing 2 common models for management of warfarin therapy; pharmacist-led service versus usual medical care

Abstract

Despite a growing body of literature supporting the potential benefit of pharmacist-managed warfarin therapy (PMWT), comprehensive reviews regarding this topic are still lacking. A systematic search of literature was done in Pubmed/Medline, Scopus, Google Scholar, and Cochrane Library from database inception to January 2014. Studies comparing PMWT with usual medical care (UMC) regarding the control of anticoagulation, bleeding and thromboembolic events, mortality, hospitalization, emergency department visit, cost, patients' satisfaction, and quality of life were included. Of 758 potential articles identified, 24 studies (4 randomized controlled trials [RCT] and 20 non-RCT studies) with a population of 11,607 were included. Among non-RCT studies, the percentage of time in the therapeutic range (72.1% vs 56.7%; P = .013), major bleeding events (0.6% vs 1.7%, P < .001), thromboembolic events (0.6% vs 2.9%; P < .001), hospitalization (3% vs 10%; P < .001), emergency department visits (7.9% vs 23.9%; P < .0001) significantly favored PMWT. The study supported PMWT regarding cost saving and patient satisfaction. The results showed that the PMWT model is superior to UMC in managing warfarin therapy based on observational studies. As well, it is comparable to UMC based on RCT studies.

Keywords: anticoagulation control; bleeding and thromboembolism; cost; hospitalization; mortality; patients’ satisfaction; pharmacist; systematic review; warfarin.