Dr. Peterson is a clinical pharmacy specialist in primary care, and Dr. Geison was a PGY-1 pharmacy practice resident at the Clement J. Zablocki VAMC in Milwaukee, Wisconsin, at the time this project was conducted. Dr. Geison is a clinical staff pharmacist at Advocate BroMenn Medical Center in Normal, Illinois.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
References
Another limitation of this project was that the bleeding risk evaluation occurred at only 1 visit. Patients’ medications and medical issues often change with time. Therefore, it is important to implement a process to regularly review (eg, annually) patients’ bleeding risk factors and to identify and act on modifiable risk factors. Another limitation was a lack of a comparator group and the time frame of the evaluation. As a result, the authors were unable to evaluate bleeding outcomes because of the small sample size and limited time frame. Future studies could consider evaluating bleeding events as an outcome, including additional modifiable risk factors, such as excess alcohol and labile INR, expanding the review to patients taking warfarin for indications other than AF, and review of patients on direct-acting oral anticoagulants (DOACs) with AF; keeping in mind that currently available bleeding risk calculators were developed for patients taking warfarin, not DOACs with AF. Patients could be counselled on reducing alcohol intake or switching to a DOAC if INR is labile despite adherence.
Conclusion
This quality improvement project successfully implemented use of the HAS-BLED bleeding risk score to identify and reduce modifiable bleeding risk factors in patients with AF taking warfarin. Pharmacist intervention resulted in a reduction of HAS-BLED scores and bleeding risk categories.
