Prospective cohort study of a pharmacological follow-up program of anticoagulated patients admitted to nursing homes

Introduction. Anticoagulant treatment, despite providing a clear benefit to prevent and treat thrombo-embolic disease, is difficult to manage in routine practice. This is due to individual variability of dosing, narrow therapeutic margin, drug interactions, and side effects. An increasing number of patients admitted to nursing homes are under oral anticoagulant therapy because of deep venous thrombosis and, especially, atrial fibrillation. These are patients with a profile that makes prescription of anticoagulant treatment more difficult - elderly, taking multiple concomitant medications and with multiple ailments. Objetive. We hypothesized that the implementation of a primary care pharmacological follow-up program of oral anticoagulant therapy in patients admitted to nursing homes, with the purpose of coordinating the different professionals and care levels, would lead to greater benefit and reduction of side effects. Methods. A one-year descriptive prospective cohort study was conducted of 27 patients admitted to nursing homes who are under anticoagulation therapy followed by the primary care team. We analyzed different variables obtained from computerized medical records, from which indicators on the program were established (coverage and registration) as well as outcome indicators (as defined by the British Committee for Standards in Haematology). Results. The profile of patients under anticoagulation and admitted to nursing homes is elderly (84 years), with a predominance of women (70%), atrial fibrillation as most frequent indication (70.4%), hypertension as major cardiovascular risk factor (92%) and most of them on multiple drugs (92%). The analysis of the program results showed excellent coverage and registration indicators (100%). Outcome indicators also showed good results, with percentages of optimal international normalized ratio of 78% (exceeding the defined minimum standard) and very low rates of complications (3%). Conclusions. The implementation of a pharmacological follow-up program for patients treated with anticoagulant therapy and admitted to nursing homes, shows positive results in relation to program set-up and clinical results, in spite of patient’s advanced age, co-morbidities and multiple medications.