Abstract
A pharmacy-managed protocol for warfarin use in orthopedic surgery patients was studied. In 1990 a protocol designed to accommodate either protocol or physician-determined dosing of warfarin for orthopedic antithrombotic prophylaxis (OAP) was implemented at a community hospital. A 'protocol' group consisting of patients treated entirely under the protocol- determined dosing option was prospectively identified over a two-year period. A 'physician' group consisting of patients treated by physicians in the 10 months immediately preceding implementation of the protocol was also identified. The ability of the protocol to achieve laboratory-test and clinical goals was assessed by comparing the two groups. The proportion of patients who received OAP increased from 89% for the physician group to 98% for the protocol group. Mean prothrombin times (PTs) were significantly higher in the protocol group only on postoperative day 2; 66% of all PTs beyond postoperative day 1 in the protocol group were within the targeted range, which reflected an International Normalized Ratio of 1.6-3.2. The frequencies of clinically apparent postoperative thromboric events and bleeding episodes were low in each group and comparable to literature values. Analysis of protocol-group patients with PTs of >20 seconds indicated that lower weight, female sex, and blood loss during surgery were associated with an elevated PT. The protocol was revised to provide for a lower initial warfarin dose in elderly women. A pharmacy-managed protocol for dosing warfarin achieved therapeutic goals and promoted nearly universal use of OAP in patients undergoing high-risk orthopedic surgery.
Original language | English (US) |
---|---|
Pages (from-to) | 1310-1316 |
Number of pages | 7 |
Journal | American Journal of Health-System Pharmacy |
Volume | 52 |
Issue number | 12 |
State | Published - Jan 1 1995 |
Keywords
- Anticoagulants
- Dosage
- Geriatrics
- Pharmaceutical services
- Pharmacy, institutional, hospital
- Physicians
- Prescribing
- Protocols
- Toxicity
- Warfarin
- Women