Anticoagulation service can be defined as a service provided by pharmacists to obtain a rational anticoagulation therapy, safe, accurate, and cost-effective. Anticoagulation service was originally carried out by a doctor. But along with the development of health care system, anticoagulation service is then performed by pharmacists (Amy, DW, et al. 2001).
In addition to its health care system development, role switching is also based on several related studies on the effectiveness of anticoagulation therapy by pharmacists versus physicians. In general, the results of these studies stated that the pharmacy anticoagulation service is better than the anticoagulation service doctor (Robert, A., et al, 1996, Dager, WE, et al, 2007, Biscup-Horn, PJ, et al 2008).
Anticoagulation services should be held because of the prevalence of use of anticoagulation drugs, especially oral anticoagulation, is quite high (Baglin, DG, et a 2008). lObat oral anticoagulation is often used is warfarin. warfarin has a narrow therapeutic range and can interact with medications and certain foods. Therefore, patients receiving warfarin therapy lab data must be closely monitored, certainly has a high adherence, and detection of potential occurrence of bleeding (Amy, DW, et al. 2001).
- 1. Bridging the doctor and patient in the system of systematic anticoagulation therapy service.
- 2. Reducing the likelihood of unwanted effects (such as bleeding) due to failure of anticoagulation therapy.
- 3. Improving the quality and consistency of service through the development and implementation of guidelines anticoagulation therapy.
Among them (Sara, R.V., et al 2009):
- Ø For caregivers: eliminates the need to engage in therapy antikogulant that takes every day.
- Ø For doctors: anticoagulation therapy ease the transition from inpatient to outpatient care, eliminating the need to engage in therapy antikogulant that takes every day, the delegation of responsibility to serve the orthopedic patient anticoagulation.
- Ø For pharmacists: simplifying the procedures for handling drug interactions and anticoagulation therapy, obtain the authority involved in the treatment of anticoagulation therapy, and to develop pharmacy services.
- Ø For patients: reducing the rate of bleeding due to the use of excessive anticoagulation, reducing the incidence of hospitalization due to bleeding, lower incidence of hospitalization due to tromboembolisme, shorten time to hospital, reduce maintenance costs, and lower mortality (Bond, CA, et al 2004).
Anticoagulation services include: initiation of therapy, patient education, blood examination schedule, anticoagulation medication dosage adjustments, drug side effect management, and termination of therapy if possible (Amy, DW, et al. 2001). Anticoagulation service can take place either in hospitals or in clinics. Should an anticoagulation service can last for 7 x 24 hours.
INR, or international normalized ratio is a parameter used in the adjustment of warfarin dose, oral anticoagulation. INR obtained from equation (Hirsh, J., et al 2003):
INR = (Patient PT/MRI PT) ISI
INR = (Patient PT/MRI PT) ISI
PT = prothrombin time / detik
MRI = rerata prothrombin time
ISI = indek sensitivitas internasional, dipengaruhi oleh reagen
When used heparin anticoagulation therapy, then the parameter is the value of the aPTT (activated partial tromboplastine time) (Hirsh, J., et al 2001).
By providing counseling, monitoring, and education to the patient, the pharmacist will be able to improve the therapeutic outcome of patients. Counselling conducted to determine the complaints and problems related to therapy. Monitoring mainly occur under laboratory examination schedule. If patients forget to visit the lab, then the patient should be warned. By doing these three things the patient will feel involved in anticoagulation therapy in which they live (Wofford, JL, et al 2008).
In addition, for anticoagulation services to run smoothly it should be supported with the financial strength, support optimal hospital, pharmacist-physician relationship is harmonious, as well as a review of the anticoagulation service workflows (Sara, RV, et al 2009).
DAFTAR PUSTAKA
- Rizki.P, M.Fatoni, et al, Anticoagulan Service.
- Amy, D., Waterman, PhD., Gerald, Banet, MSN., MPH., Paul, E. Milligan, RPh., Andrea, Fraizer, R.N., B.S., Ellen, Verzino, PharmD, Brian ,Walton, M.D., Brian, F., Gage, M.D., MSc. Patient and physician satisfaction with telephone-based anticoagulation service. J Gen Intern Med 2001:16:460-463.
- Robert, A.,. Hughes, Workshop: Reimbursement for anticoagulation services. Journal of Thrombosis and Thrombolysis 1996:2:301-304.
- Dager, W.E., Gulseth, M.P. Implementing anticoagulation management by pharmacists in the inpatient setting. American Journal Of Health-System Pharmacy 2007: 64 :1071-1079.
- Biscup-Horn, P.J., Streiff, M.B., Ulbrich, T.R., Nesbit, T.W., Shermock, K.M. Impact of an inpatient anticoagulation management service on clinical outcomes.. The Annals Of Pharmacotherapy 2008:42: 777-82.
- Baglin, D.G., Cousin, D., Keeling, D.M., Perry, D.J., Watson, H.G. Safety Indicators for inpatient and outpatient oral anticoagulant care. Recommendation from British comitte for Standards in haematology (BCSH) and National Patient Agency 2008.
- Sara, R.V., Campbell, J., Hamann, G., George, C., Spabery, L. Anticoagulation clinic workflow. J AM Pharm Assoc 2009:49:78-85.
- Hirsh, J., Fuster, V., Ansell, J., Halperin, J.L. American Heart Association / American College of Cardiology Foundation Guide to Warfarin Theraphy. Circulation 2003:107:1692-1711.
- Hirsh, J., Anand, S.S., Fuster, V., Ansell, J., Halperin, J.L. American Heart Association / American College of Cardiology Foundation Guide to Anticoagulant Theraphy: Heparin. Circulation 2001:103:2994-3018.
- Wofford, J.L., Wells, M.D., Sing, S. Best strategies for patient education about anticoagulation with warfarin: a systematic review. BMC Health Service Research 2008:8:40.
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