Sample Literature Review Writing


From the time when heparin and warfarin has become obtainable, the prevention and administration of thromboembolism and the consideration of dosing methods and observation of anticoagulant therapy has constantly evolved. Current expansions presented in anti­coagulant therapies and supplementary information concerning their most favorable use has shaped more options and administration contemplations when planning anti­coagulation therapy. To deal with this, numerous health care professionals gradually identified the possible advantages of pharmacist input with administering anticoagulant therapy. Further, the accessibility of heparin and warfarin for the prevention and management of thromboembolism and the notion on dosing approaches and supervising of anticoagulant therapy has insistently developed (Dager and Gulseth, 2007). Studies show that millions of patients are given anticoagulants for the deterrence of thromboembolic procedures (Garcia D.A., Witt D.M., and Hylek E, 2008). Maintenance anticoagulation therapy (ACT) was arranged for a range of therapeutic results and state, counting history of myocardial infarction, indwelling myocardial stents, atrial fibrillation, mechanical heart valves implant, record of thromboembolism, and preclusion of stroke (Eisenstein, 2012). Moreover, pharmacists have played a significant part in managing anticoagulation therapy, both on hospitalized patients and outpatients with their proper training of both fundamental pathophysiology on blood clotting as well as the essentials of medical clotting mayhems. Pharmacists’ conveys their knowledge in medical pharmacology and drug relations to the ground of patient administration whereas most physicians do not have the pharmacology education essential to optimally administer risky anticoagulants such as warfarin. Countless are taught austerely by practice, however this can be risky if only a small number of patients are treated yearly (Dager and Gulseth, 2007).

Anticoagulation Therapy

Anticoagulation medications helps thwart blood clots from forming and aids with the prevention of post operative problems caused by the formation of clots, for instance heart attack, pulmonary embolism, or deep vein thrombosis. This medication may also be prescribed for patients at risk of blood clots such as the immobile, obese, and those on bed rest. Commonly, the medicines used for ACT include heparin and warfarin (California StateBoard of Pharmacy, 1999). Anticoagulants are counted as medications frequently concerned in undesirable drug measures, several of which are avertable (Gurwitz JH, Field TS, Harrold LR, et al., 2003).  Heparins and warfarins are “anticoagulants,” sometimes called as “blood thinners,” principally used to thwart clot (thrombus) formation and the addition of present thrombi (California StateBoard of Pharmacy, 1999).

The California State Board of Pharmacists (1999) further conferred that optimal administration of anticoagulated patients lessens therapeutic malfunctions and bleeding snags, thereby achieving positive patient results and lessening chances of hospitalizations as well as health care expenses. Accumulating proofs signifies that the management of warfarin is enhanced when given through a committed anticoagulation management service (AMS) fairly than through usual medical care wherein routine medical care (RMC) is usually based on physician office with phone call follow-ups subsequent to central laboratory examinations.

The Pharmacists Role

Throughout the process of anticoagulation therapy, several health care professionals are involved with patient care, wherein the role of the pharmacist is pain staked as multi-factorial and can take in, however is not restricted to, the option, scrutinizing, dosing and stipulation of drug, patient education, drug communication screening and finally, research (California State Board of Pharmacy, 1999). Further, throughout 1970’s, pharmacist-administered anticoagulation clinics commenced and are presently considered as the most extensive and flourishing joint drug therapy administration programs. In 1992, a study on medication-related mishaps and inquiries from prescribing medical doctors acknowledged an undesirable occurrence of prescription associated unfavorable events taking place in hospitalized patients getting anticoagulants (Dager and Gulseth, 2007).

Moreover, Dager and Gulseth (2007) conferred that a triumphant patient anticoagulation management program takes in the significance of the pharmacist’s role in categorizing patient needs, achieving sustenance from health care professionals and devising a plan that will address patient’s needs as  well as managing unanticipated issues. In 1985, the University of California Davis Medical Center (UCDMC) founded an outpatient anticoagulation clinic wherein findings on prescription associated mishaps and inquiries from medical professionals recognized an unwanted occurrence of medication-related unfavorable measures taking place among patients receiving anticoagulants confined within hospitals. With the demands of the medical professionals, pharmacists were tasked to aid and assist with the management of anticoagulants (Dager and Gulseth, 2007). Consequently, the recognition of pharmacist input on management concern by medical staffs in due course as well as the apprehension that latest information, varying policies, and the accessibility of newer evaluation methods were hastily included into patient supervision, the service supplier was more precisely portrayed as an anti-thrombosis examination rather than a service created deliberately for anticoagulation therapy. Pharmacist’s activity takes in helping the choosing of anticoagulants to be employed according to guidelines set by pharmacies and therapeutics board, instigating cure and follow-up monitoring for warfarin and in a number of circumstances, unfractioned heparin (UFH). The service lengthened includes supervising heparin-induced thrombocytopenia (HIT); recombinant factor VIIa, or Vitamin K setback; assessing requests for low-molecular-weight heparin (LMWH), facilitating selected on-going investigational tests and fondaparinux (Kaplan B.C, Trischwell D.L., and Longstreth W.T Jr., 2005). Additionally, pharmacists’ eases care strategies for patient’s transfer towards outpatient setting. This integrated patient learning, confirmation of insurance coverage of the preferred anticoagulant, organization of follow-up care with coexisting overlying therapies such as bridging and finally, organizing immediate follow-up when necessary (Dageer, W. E, King, J. H, Chow, S et al. 2005).

Further, published interpretations collected from different in­stitutions assess pharmacists’ involvement in supervising inpatient anticoagulation points to reliable indication of enhanced clinical results whereas reducing the cost of therapy. In a report published by Bond and Raehl (2004; 953), the prospective result of pharmacist participation in managing either UFH or warfarin was examined and the outcomes presented additional data which supports the observations on various studies. Furthermore, hospitals with pharmacists that provide administration of either heparin or warfarin were examined to have considerably (p < 0.001) lesser anticoagulation associated bleeding complications, cost of therapy, length of hospital stay, blood transfusion requirements, and death. Considering that anticoagulants, such as warfaring and heparin, are normally employed in hospitals that have been regularly coupled with harmful recommendation errors, the authors concluded that “pharmacy directors and clinical coordinators should develop pharmacist-provided anticoagulation management as an integral component of their core service mix” (Bond and Raehl, 2004).


This study addresses the health care systems and physicians increasing recognition of the potential benefits of pharmacist involvement in the management of anticoagulant therapy. Considering all available evidences which demonstrates that pharmacist-managed anticoagulation services which is supposed by medical practitioners to improve patient outcomes, reducing hospitalizations and emergency care for both bleeding and thrombotic complications and leading to a decrease overall health care costs, This study aims to analyze the effects of pharmacist’s input into anticoagulation therapy outcomes while taking into great consideration its safety and efficacy.


Bond, C.A., Raehl C.L., 2004. Pharmacist provided anticoagulation management in United States: death rates, length of stay, medicare charges, bleeding complications, and transfusions. Pharmacotherapy, 24, pp.953-63.

California StateBoard of Pharmacy, 1999. Pharmacist involvement in anticoagulant therapy: how patients benefit. Sacramento, CA : Consumer Education and Communication Committee, California State Board of Pharmacy.

Dager, W. E. and Gulseth, M.P., 2007. Implementing anticoagulant management by pharmacists in the inpatient setting. Available at: <> [Accessed 14 September 2012]

Dageer, W. E, King, J. H, Chow, S., 2005. Outpatient tinzaparin in patients with pulmonary embolism or deep vein thrombosis. Pharmacotherapy, 39, pp. 1182-7.

Eisenstein, D. H., 2012. Anticoagulation management in the ambulatory surgical Setting. AORN Journal, 95(4).

Garcia, D.A., Witt, D. M., Hylek E., 2008. Delivery of optimized anticoagulant therapy: consensus statement from the Anticoagulation Forum. Ann Pharmacother, 42(7), pp.979-988.

Gurwitz J.H., Field T.S., and Harrold LR. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA, 289(9), pp.1107-1116.

Kaplan B.C., Trischwell D.L., Longstreth, W.T., 2005.Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology, 65(6), pp.835-842.

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