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Interventions to Improve Anticoagulation With Warfarin

Castro, Tatiane Araujo MSc*,†; Heineck, Isabela MD, PhD

doi: 10.1097/FTD.0b013e318248b0e6
Original Article

Introduction: This study aimed to investigate potential drug–drug interactions (pDDIs) with warfarin to minimize them, assess the acceptability of pharmaceutical interventions by the medical team and the impact on the international normalized ratio (INR) results.

Methods: This pertains to a prospective study involving inpatients who started warfarin therapy in a university hospital located in southern Brazil. The pDDIs with warfarin were identified using the interaction screening program Drug-Reax, Micromedex Healthcare Series 1.0.

Results: Two hundred and two inpatients were monitored. The mean of 10 different drugs was prescribed for each patient (SD = 3.6). At least 1 major or moderate pDDIs with warfarin per patient was observed, the mean was 3.6 (SD = 1.6). The most common pDDIs with warfarin involved in the increase of anticoagulation effect were enoxaparin (32.2%), simvastatin (27.6%), omeprazole (22.5%), and tramadol (21.5%). For 32 patients (15.8%), interventions were rejected, and they had a higher risk (relative risk= 2.17; 95% confidence interval 1.10–4.27) for abnormal test results (INR > 5). Multivariate analysis showed that age, length of hospital stay, exposure to ≥4 major or moderate pDDIs, and refusal of pharmacist recommendations contribute significantly to the patient's INR result >5. Consequently, the risk of bleeding is increased.

Conclusions: Major and moderate pDDIs with warfarin are very common in inpatients and are associated with INR results outside the therapeutic range. Pharmaceutical interventions concerning the management of interactions by providing information to physicians can improve the patient safety.

*São Lucas University Hospital, Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Farmácia clínica, Porto Alegre, RS, Brazil

Programa de Pós-graduação em Ciências Farmacêuticas da Universidade Federal do Rio Grande do Sul, Departamento de Producão e Controle de Qualidade de Medicamentos, Porto Alegre, RS, Brazil

Programa de Pós-graduação em Ciências Farmacêuticas da Universidade Federal do Rio Grande do Sul, Departamento de Producão e Controle de Qualidade de Medicamentos, Porto Alegre, RS, Brazil.

The authors declare no conflict of interest.

Correspondence: Tatiane Araujo de Castro, MSc, Clinical Pharmacy, São Lucas University Hospital, PUCRS, Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul., Av Ipiranga, n° 6690, 90160-090 Porto Alegre, RS, Brazil (e-mail: tatiaraujocastro@gmail.com).

Received October 15, 2011

Accepted December 22, 2011

© 2012 Lippincott Williams & Wilkins, Inc.