Survey of pharmacists' subtherapeutic INR management and anticoagulation bridging practices. Maxwell, W. D.; Shrader, S. P.; Moore, K. G.; Lu, Z. K.; and White, S. F. Journal of Clinical Pharmacy and Therapeutics, June, 2015. 00001
doi  abstract   bibtex   
WHAT IS KNOWN AND OBJECTIVE: Despite extensive warfarin use, optimal management of subtherapeutic international normalized ratios (INRs) remains unclear. This study assessed the differences in bridging practices among pharmacists with varying levels of experience, residency training and prescribing privileges. METHODS: An electronic survey was distributed to two ambulatory care pharmacist e-mail lists. Respondents indicated if they would utilize parenteral anticoagulation bridging in 16 clinical scenarios at three therapeutic time points. The scenarios included patients with atrial fibrillation (AFib) (CHADS2 score of 3-4), AFib (CHADS2 score of 5-6) and venous thromboembolism (VTE). The AFib time points were as follows: anticoagulation initiation, early phase (\textless1 month) and maintenance phase (\textgreater1 month). VTE time points included early phase (\textless1 month), months 2-3 and maintenance phase (\textgreater3 months). RESULTS AND DISCUSSION: The survey was completed by 143 respondents. In only three of the scenarios did \textgreater50% of respondents indicate they would utilize parenteral anticoagulation bridging. No statistically significant differences in bridging practices were identified between pharmacists providing anticoagulation services in different clinic settings. However, there were significant differences in bridging practices between pharmacists with varying levels of experience, residency training and prescribing privileges in some, but not all of the scenarios. WHAT IS NEW AND CONCLUSION: The standards of care for subtherapeutic INRs warrant further definition.
@article{maxwell_survey_2015,
	title = {Survey of pharmacists' subtherapeutic {INR} management and anticoagulation bridging practices},
	issn = {1365-2710},
	doi = {10.1111/jcpt.12300},
	abstract = {WHAT IS KNOWN AND OBJECTIVE: Despite extensive warfarin use, optimal management of subtherapeutic international normalized ratios (INRs) remains unclear. This study assessed the differences in bridging practices among pharmacists with varying levels of experience, residency training and prescribing privileges.
METHODS: An electronic survey was distributed to two ambulatory care pharmacist e-mail lists. Respondents indicated if they would utilize parenteral anticoagulation bridging in 16 clinical scenarios at three therapeutic time points. The scenarios included patients with atrial fibrillation (AFib) (CHADS2 score of 3-4), AFib (CHADS2 score of 5-6) and venous thromboembolism (VTE). The AFib time points were as follows: anticoagulation initiation, early phase ({\textless}1 month) and maintenance phase ({\textgreater}1 month). VTE time points included early phase ({\textless}1 month), months 2-3 and maintenance phase ({\textgreater}3 months).
RESULTS AND DISCUSSION: The survey was completed by 143 respondents. In only three of the scenarios did {\textgreater}50\% of respondents indicate they would utilize parenteral anticoagulation bridging. No statistically significant differences in bridging practices were identified between pharmacists providing anticoagulation services in different clinic settings. However, there were significant differences in bridging practices between pharmacists with varying levels of experience, residency training and prescribing privileges in some, but not all of the scenarios.
WHAT IS NEW AND CONCLUSION: The standards of care for subtherapeutic INRs warrant further definition.},
	language = {eng},
	journal = {Journal of Clinical Pharmacy and Therapeutics},
	author = {Maxwell, W. D. and Shrader, S. P. and Moore, K. G. and Lu, Z. K. and White, S. F.},
	month = jun,
	year = {2015},
	pmid = {26086075},
	note = {00001 },
	keywords = {Peer-Reviewed Manuscripts}
}
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