Effectiveness of pharmacist-participated warfarin therapy management: A systematic review and meta-analysis

Saokaew, S., Permsuwan, U.., Chaiyakunapruk, N., Nathisuwan, S. and Sukonthasarn, A. (2010) Effectiveness of pharmacist-participated warfarin therapy management: A systematic review and meta-analysis. Journal of Thrombosis and Haemostasis, 8 11: 2418-2427. doi:10.1111/j.1538-7836.2010.04051.x

Author Saokaew, S.
Permsuwan, U..
Chaiyakunapruk, N.
Nathisuwan, S.
Sukonthasarn, A.
Title Effectiveness of pharmacist-participated warfarin therapy management: A systematic review and meta-analysis
Journal name Journal of Thrombosis and Haemostasis   Check publisher's open access policy
ISSN 1538-7933
Publication date 2010-11-01
Sub-type Article (original research)
DOI 10.1111/j.1538-7836.2010.04051.x
Volume 8
Issue 11
Start page 2418
End page 2427
Total pages 20
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
Objective: Although pharmacist-participated warfarin therapy management (PWTM) has been accepted and implemented in various parts of the world, the evidence demonstrating the effects of PWTM compared with usual care on clinical outcomes is lacking. We performed a systematic review and meta-analysis to compare the effects of PWTM with usual care on bleeding and thromboembolic outcomes.
We searched MEDLINE, SCOPUS, EMBASE, IPA, CINAHL, Cochrane CENTRAL, Thai Index Medicus and Thai Medical Index, and reference lists of studies, without language restriction. Databases were searched from their inception to July 2009. The studies using warfarin as an anticoagulant with sufficient data for compilation of 2 × 2 tables were included. Both randomized controlled trials (RCTs) and non-RCTs were considered. Two authors independently reviewed each study, assigned quality scores and extracted data for all outcomes using a standardized form. Pooled effect estimates (risk ratio; RR) were obtained using a random effects model. Result: Of 661 articles identified, 24 studies with 728,377 patients were included. In the random-effects meta-analysis of RCTs, the PWTM group had statistically significant effects on the prevention of total bleeding [RR, 0.51; 95% confidence interval (CI), 0.28-0.94]. However, the effects on major bleeding (RR, 0.64; 95% CI, 0.18-2.36), thromboembolic events (RR, 0.79; 95% CI, 0.33-1.93), all-cause mortality (RR, 0.93; 95% CI, 0.41-2.13) and warfarin-related mortality (RR, 0.65; 95% CI, 0.18-2.42) were not significant. Conclusion: Pharmacist's participation in the management of warfarin therapy significantly reduces total bleeding, with a non-significant trend towards decreases in other warfarin-related complications. © 2010 International Society on Thrombosis and Haemostasis.
Keyword Anticoagulation clinic
Systematic review
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 22 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 06 Mar 2011, 10:07:51 EST