암환자의 항응고약물 치료에 있어서 항응고약물 상담(Anticoagulation service, ACS) 효과 평가
Evaluation of Effectiveness on Anticoagulation Therapy with Pharmacist-managed Anticoagulation Service in Patients with Cancer
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초록
Thromboembolic events such as deep vein thrombosis(DVT) and pulmonary thromboembolism( PTE) are common among patients with cancer as a consequence of cancer- and treatmentrelated factors and have an effect on prognosis. Also, these events are the second most frequent cause of death in cancer patients. In 2008, Samsung Medical Center started the Anticoagulation service(ACS) which is a pharmacistmanaged anticoagulation service for cancer patients taking warfarin. The purpose of this study is to evaluate the effectiveness of ACS in patients with cancer. In this retrospective study, patients were first time warfarin users at Samsung Medical Center from March 31, 2010 to March 31, 2013. Each patient was followed up for 6 months after taking warfarin for at least 3 months. Patients were divided into two groups: ACS group(n=61) and non-ACS group (n=23). This study analyzed the baseline characteristics, warfarin indications, cancer types, contributing factors then compared anticoagulation control. The most common cancer type was lung cancer: 40.98%(n=25) of the ACS group and 65.22%(n=15) of the non-ACS group. The most common indications for warfarin in both groups were PTE or DVT. The ACS group spent significantly more time in the therapeutic range(TTR, 25.24±24.13% vs 47.43± 22.20%, p>0.001), as well as in the expanded therapeutic range(TTR within±0.2 units, 39.89±29.81% vs 65.40±22.67%, p=0.001). The percentage of time in the extreme range(INR <1.5 or >4.0) was 37.8 ±35.4% vs 20.5±19.5%(p=0.09). The interval of INR monitoring was 24.2±11.2 days vs 13.0±4.6 days (p<0.001). There was no major bleeding in both groups. The incidence of minor bleeding was 0.926/person-year in the ACS group and 0.815/person-year in the non-ACS group. These findings suggest that ACS group patients managed by pharmacists achieved significantly better INR control compared to non-ACS group patients as measured by the patients’INR values over time. These values remained in the therapeutic and expanded range. Based on the results of this study, collaborative practice using pharmacists and physicians may be an effective model for anticoagulation management for cancer patients.
Abstract
Thromboembolic events such as deep vein thrombosis(DVT) and pulmonary thromboembolism( PTE) are common among patients with cancer as a consequence of cancer- and treatmentrelated factors and have an effect on prognosis. Also, these events are the second most frequent cause of death in cancer patients. In 2008, Samsung Medical Center started the Anticoagulation service(ACS) which is a pharmacistmanaged anticoagulation service for cancer patients taking warfarin. The purpose of this study is to evaluate the effectiveness of ACS in patients with cancer. In this retrospective study, patients were first time warfarin users at Samsung Medical Center from March 31, 2010 to March 31, 2013. Each patient was followed up for 6 months after taking warfarin for at least 3 months. Patients were divided into two groups: ACS group(n=61) and non-ACS group (n=23). This study analyzed the baseline characteristics, warfarin indications, cancer types, contributing factors then compared anticoagulation control. The most common cancer type was lung cancer: 40.98%(n=25) of the ACS group and 65.22%(n=15) of the non-ACS group. The most common indications for warfarin in both groups were PTE or DVT. The ACS group spent significantly more time in the therapeutic range(TTR, 25.24±24.13% vs 47.43± 22.20%, p>0.001), as well as in the expanded therapeutic range(TTR within±0.2 units, 39.89±29.81% vs 65.40±22.67%, p=0.001). The percentage of time in the extreme range(INR <1.5 or >4.0) was 37.8 ±35.4% vs 20.5±19.5%(p=0.09). The interval of INR monitoring was 24.2±11.2 days vs 13.0±4.6 days (p<0.001). There was no major bleeding in both groups. The incidence of minor bleeding was 0.926/person-year in the ACS group and 0.815/person-year in the non-ACS group. These findings suggest that ACS group patients managed by pharmacists achieved significantly better INR control compared to non-ACS group patients as measured by the patients’INR values over time. These values remained in the therapeutic and expanded range. Based on the results of this study, collaborative practice using pharmacists and physicians may be an effective model for anticoagulation management for cancer patients.
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