By Anne Rose

In addition to appearing as a coaching consultant for pharmacists, pharmacy citizens and pharmacy scholars who search to perform in components linked to sufferers on anticoagulant treatment, the data provided inside of highlights the becoming position of the pharmacist in those contexts. Readers will locate precious info on anticoagulant administration throughout all pharmacy perform parts, together with the inpatient, ambulatory, emergency prone and transitions of care settings. specific consciousness is given to summarizing most sensible practices and delivering ‘real global’ examples of the way within which pharmacists may be focused on anticoagulation administration and the effect of such involvement. within the first significant part of the publication, every one bankruptcy specializes in the position of the pharmacist within the administration of drugs with a selected kind of anticoagulants (e.g. warfarin, heparin and target-specific oral brokers) in numerous healthcare settings. A broader assessment of the medical administration of anticoagulation treatment is equipped within the moment significant part, together with descriptions of the position of pharmacists in assessing venous thromboembolism danger, making sure sufferers obtain applicable prophylactic treatment, and tracking outcomes.

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Extra resources for Anticoagulation Management: A Guidebook for Pharmacists

Sample text

2 Case 2 Mr. OB is a 70-year-old man with a mitral valve prosthesis placed 3 years ago. He is on warfarin 6 mg per day with good INR control. Yesterday, he was seen with symptoms of an acute urinary tract infection and prescribed one double-strength tablet of trimethoprim-sulfamethoxazole (TMP-SMX) twice daily for 10 days. He is allergic to ampicillin and has gastric intolerance to tetracycline. He calls to inform the anticoagulation clinic he is starting a new antibiotic and is wondering if his warfarin dose should be adjusted?

Educate the patient (and other healthcare providers). Assess compliance with a regimen. Review medications, comorbidities, and dietary intake. Screen for recurrence of thrombosis or bleeding events. These activities should be incorporated in the protocols establishing the role of the pharmacist in warfarin management in ambulatory setting. 4 Warfarin Management Guidelines and Protocols A number of studies have evaluated several strategies to manage warfarin dosing in the ambulatory setting. Some of these strategies included dosing nomograms, warfarin dose equations, genetic guidance, and empiric dosing [37–47].

Based on the initial assessment of the patient the recommended warfarin dose is 5 mg ×1 4. A clinical pharmacist will continue to monitor the INR daily and adjust the warfarin dose as needed. Fig. 7 5 mg × 1 5 mg × 1 5 mg × 1 ordered Patient Assessment: Previous warfarin dose omitted: {yes/no} Significant drug interactions: {*** started/stopped on *** or none} Signifiant diet changes: select one {dietary supplements/ileus/ NPO/ tube feeding Bleeding Risk Assessment: Blood documented in: Select all that apply • emesis • urine • sputum • stool • wound site • blood products received *** Stable • Hgb stable • Plt stable Upcoming surgery or procedure: {yes/no} if yes specify what surgery and date Warfarin Dosing Recommendations: Test, Patient is a 34 year old patient prescribed warfarin for pulmonary embolism.

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