audit evaluating anticoagulation clinic managed by clinical pharmacists in Jordan

Background and Objectives: Warfarin is the most widely prescribed oral anticoagulant; it is highly effective for the treatment and prevention of venous and arterial thrombosis. The beneficial outcomes of warfarin therapy are dependent upon achieving and maintaining an optimal international normalized ratio [INR] therapeutic range. The aim of this study was to evaluate the impact of our newly established clinic at Queen Alia Heart Institute [QAHI] in the Royal Medical Services [RMS], Jordan

Patients and Methods: An observational prospective study was carried out in a newly established anticoagulation clinic managed by two clinical pharmacists and one nutritionist in QAHI since September 2013 until June 2014. The patients [no= 250] who were on warfarin for at least two months referred to the clinic were included in our study. All patients or their care givers received a 45 minutes educational session and a warfarin booklet. Then they were followed up regularly for achieving and maintaining the target INR and developing any adverse events related either too high or low INR [>4.5 or <1.5, respectively]

Results: The age range of this group of the patients who were referred to t he clinic was wide, 5-81 years. 65% of them were males, with the most common indications for Warfarin were aortic and mitral valves replacement, and atrial fibrillation.72% of the patients were not achieving therapeutic [T] INR 43% of them achieve the TINR within the first week, 28% within the second week, 17% within the third, 4% within the fourth and 8% exceeded 4 weeks. The proportion of time within TINR for all the patients during the whole period was 75%. Only 7% of the patients had low INR, <1.5 and 5% had high INR, >4.5 for one visit. No major thromboembolic or hemorrhagic events were reported

Conclusion: The newly established clinic had achieved a considerable encouraging results and feedbacks in the short period of time since it had been established

Pregabalin efficacy and tolerability: a clinical point of view

Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently developed antiepileptic drug also used in management of chronic neuropathic pain conditions. The aim of this observational prospective study was to assess the analgesic efficacy and associated adverse events of pregabalin in treated patients with neuropathic pain. The source of medication was the free samples that have been provided by the company for evaluation. MethodsNeurologists and Endocrinologists at king Hussein Medical Center prescribed Pregabalin for selected patients [no. =50] who were diagnosed to have neuropathic pain according to pre-formulated questionnaire that was developed by researchers. The majority of patients received Pregabalin 150mg as a starting dose, 300 mg as a maintenance dose for three months, then the magnitude of pain was assessed first after one week of treatment, if the patient had pain relief after one week and maintained on treatment further assessment was performed at intervals of one, two and three months. Then for each patient the average score of pain relief was calculated [0=worst value, 10=best value].patients were also encouraged to report any adverse effect during treatment period. A total of 50 patients with neuropathic pain were included. During the course of the study 17 patients terminated treatment during the first week [but were replaced by other 15 patients] either due to lack of efficacy [12%, n=6] or due to intolerable adverse effects [22%, n= 11]. For the remaining patients the average score of pain relief was 2.8 +/- 1.2. The average score of pain reduction was higher among patients with diabetic neuropathy [3.4] than with other types of neuropathic pain [2.2]. The most frequently reported adverse effects were dizziness, fatigue, somnolence, and gastrointestinal disturbances. Pregabalin is effective in reducing diabetic neuropathy and to a lesser extent than other types of neuropathic pain. [But] However intolerable adverse effects still face a problem. Further studies comparing its efficacy and tolerability with other neuropathic treatment choices are needed