Wednesday, January 10, 2007

Brain Bleeds From Blood Thinner on the Rise

The knee-jerk response to this article by some would be that "Coumadin is dangerous." However, I think this has a lot more to do with poor monitoring. During my time in a hospital-based pharmacist-run anticoagulation clinic, I am regularly amazed by the casual approach of many family physicians when it comes to warfarin monitoring. This attitude results in some of the problematic cases that I see.

Physicians have a lot on their plate. It seems to make a lot of sense to offload this task to pharmacists who have studied and specialized in this area. I don't think a physician who glances at a lab report in the middle of a busy day seeing patients provides more value when compared to a specially trained pharmacist who devotes their entire day to the subject. The Alberta College of Pharmacists seems to agree as they have indicated that this could be one of the first clinical areas noticably impacted by pharmacist prescribing. I'm planning on applying for my clinical prescribing rights for warfarin and other anticoagulants when the opportunity arises later this year. It should be an interesting experience.

From Forbes:
The rate of bleeding in the brain associated with use of the anticoagulant drug warfarin quintupled during the 1990s, University of Cincinnati researchers reported Monday.

Moreover, in people over 80, the rate of brain hemorrhages associated with warfarin, best known as Coumadin and used to thin the blood and prevent strokes, increased more than tenfold, according to the study, published in the Jan. 9 issue of Neurology. ...more

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