A pilot study evaluating the feasibility of monitoring oral anticoagulant therapy with point-of-care testing in a community pharmacy

Objective: To evaluate the quality of oral anticoagulant monitoring by means of point-of-care testing in a community pharmacy, performed under the supervision of staff in a specialized hospital oral anticoagulation clinic. Methods: Participants consisted of patients receiving long-term warfarin therapy who were expected to require treatment for at least 3 months and who were patients of the hospital anticoagulation clinic or customers of the designated community pharmacy. The primary endpoint was the proportion of time for which international normalized ratio (INR) was within the expanded therapeutic range (within 0.2 INR units above or below the target therapeutic range) for 2 groups: patients who were managed through the community pharmacy and historical controls, whose treatment had been managed through oral anticoagulation clinics. Rates of thromboembolic and major hemorrhagic events and of patient satisfaction in the 2 groups were determined. Results: Nineteen patients were enrolled in this study and had their warfarin therapy managed by community pharmacists. The INR level was within the expanded therapeutic range 84% of the time (95% confidence interval [CI] 75% to 93%) for these patients and 82% of the time (95% CI 78% to 85%) for the historical controls managed through oral anticoagulation clinics (p = 0.58). No thromboembolic or bleeding events occurred in any of the 19 study participants. There was no difference between the groups in responses on patient satisfaction questionnaires. Conclusions: Community pharmacists using point-of-care testing under the supervision of staff in a hospital oral anticoagulation clinic provided warfarin management that was similar to warfarin management for historical controls attending oral anticoagulation clinics. The development of satellite anticoagulation clinics in community pharmacies may lead to a more individualized approach to therapy and eliminate the inconvenience of INR testing in hospital laboratories. Further studies of longer duration are required to determine whether community pharmacy management improves patient outcomes and is cost-effective.