Frequency and clinical outcomes of pharmacist-driven switching from warfarin to direct oral anticoagulants in an underserved patient population: A retrospective cohort study.

PURPOSE: Direct oral anticoagulant (DOAC) medications have improved safety, efficacy, and laboratory monitoring requirements compared to warfarin. However, available data are limited on the frequency and clinical outcomes of pharmacist-driven warfarin-to-DOAC switches. We aimed to quantify the frequencies and rationale of warfarin-to-DOAC switches in an underserved population. We also assessed clinical outcomes and compliance with recommended laboratory monitoring after switches. METHODS: This retrospective cohort study included adult (age 18 years or older) patients on warfarin who were assessed by a clinical pharmacist for switch appropriateness to a DOAC. Study data were collected via manual chart review and included demographics, comorbid illnesses, switch status, the rationale for or against switching, incidence of thromboses and bleeds within 6 months of the switch assessment, and the time to the first complete blood count and renal and hepatic function tests after the switch. Statistical analysis utilized descriptive statistics, including the mean and SD, median and interquartile range, and frequencies and percentages. RESULTS: Among 189 eligible patients, 108 (57%) were switched from warfarin to a DOAC. The primary rationales for switching were less monitoring (64%) and labile international normalized ratio (32%). The main reason against switching was DOAC inappropriateness (53%), such as in morbid obesity (14%). Patient preference was commonly cited in both groups (54% and 36%, respectively). The overall incidence of thrombotic events (9%) and bleeds (15%) after switch assessment was low. Laboratory monitoring after switches was consistent with current recommendations. CONCLUSION: No increase in harm was observed 6 months after switch assessment when pharmacists at a family medicine clinic switched underserved patients from warfarin to DOACs.

Assessment of Glycosylated Hemoglobin Outcomes Following an Enhanced Medication Therapy Management Service via Telehealth.

(1) Background: Regular contact with a medication therapy management (MTM) pharmacist is shown to improve patients' understanding of their condition; however, continued demonstration of the value of a pharmacist delivered comprehensive medication review (CMR) using enhanced MTM services via telehealth is needed. The study aimed to describe a pilot program designed to improve type 2 diabetes mellitus (T2DM) management through enhanced condition specific MTM services. (2) Methods: This retrospective study included patients with T2DM aged 40-75 years who received a pharmacist-delivered CMR between January and December 2018. An evaluation of glycosylated hemoglobin (HbA1c) values 3 months pre- and post-CMR was performed. Wilcoxon signed-rank and chi-square tests were used. (3) Results: Of 444 eligible patients, a majority were female (58%) with a median age of 70 years. Median HbA1c values post-CMR were lower than pre-CMR (median 7.1% range 4.5-13.6; median 7.4% range 4.5-13.9, respectively; p = 0.009). There were fewer participants with HbA1c >9% post-CMR (n = 66) than pre-CMR (n = 80; p < 0.001) and more with HbA1C <6.5% post-CMR (n = 151) than pre-CMR (n = 130; p < 0.001). (4) Conclusion: This program evaluation highlighted the value of an enhanced condition specific MTM service via telehealth. Patients had improved HbA1c values three months after receiving a single pharmacist delivered CMR.

Valproic acid as an adjunctive therapeutic agent for the treatment of breast cancer.

Breast cancer is one of the leading causes of cancer-related death among women. A significant challenge in treating breast cancer is the limited array of therapeutic options and the rapid development of resistance to existing agents. Indeed, breast cancer patients, particularly those with hormone-receptor (HR)-positive breast cancer, initially respond to systemic treatment with cytotoxic, hormonal, and immunotherapeutic agents but frequently progress to a more advanced disease that is refractory to therapy. Thus, new agents are needed to improve the effectiveness of current agents, decrease the emergence of resistance, and increase disease-free survival. To this end, numerous agents have been investigated for use in combination with existing therapies. Histone deacetylase (HDAC) inhibitors are a class of potent epigenetic modulators that have been investigated recently for their potential use in the treatment of breast cancer. In this review, we will discuss the underlying molecular rationale for using HDAC inhibitors for the treatment of breast cancer. In particular, we will focus our discussion on the FDA approved HDAC inhibitor valproic acid (VPA) which has been shown to alter proliferation, survival, cell migration, and hormone receptor expression of breast cancer cells in both the pre-clinical and clinical settings. We also discuss the promising pre-clinical data suggesting that VPA can be repurposed as an adjunctive agent in combination with many cytotoxic, hormonal, and immunotherapeutic agents for the treatment of breast cancer. Finally, we will examine the current models used to study the actions of VPA on breast cancer alone and in tandem with other agents.