Journal of the American Pharmacists Association最新文献

{"title":"Reprint of: Implementation and perception of outpatient pharmacists prescribing hormonal contraceptives in North Carolina","authors":"Joseph T. Martinez,&nbsp;Katie Trotta,&nbsp;James P. Honeycutt III,&nbsp;Charles Herring","doi":"10.1016/j.japh.2024.102172","DOIUrl":"10.1016/j.japh.2024.102172","url":null,"abstract":"<div><h3>Background</h3><div>North Carolina (NC) House Bill 96, effective February 2022, enabled trained immunizing pharmacists across the state to prescribe hormonal contraceptives (HCs). However, the extent and barriers to deployment are unknown. The purpose of this study was to describe the uptake and challenges from outpatient pharmacists who trained to provide HCs in an outpatient practice to assist others in the implementation of this service.</div></div><div><h3>Objectives</h3><div>The primary objective was to estimate the proportion of trained NC pharmacists who provided HCs in an outpatient setting. The secondary objective was to identify barriers during the implementation of this service.</div></div><div><h3>Methods</h3><div>This cross-sectional, anonymous, web-based survey was emailed on December 13, 2022, to NC-licensed pharmacists enrolled in the required training. A reminder email was sent on January 10, 2023, with all responses considered up to January 31, 2023. Pharmacists licensed in NC who performed at least 50% of their clinical practice in an outpatient setting were included. The primary endpoint was having prescribed HC (Y/N). All endpoints were analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>Of 1633 pharmacists eligible, 96 completed responses were included in the analysis (5.9%). Training was incomplete in 11 of 96 (11.5%), and 66 of 96 (68.8%) completed the training without implementing the service. Of the remaining 19 of 96 (19.8%) that developed a HC service, 15 of 96 (15.6%) had prescribed HCs. Among the 15 prescribing pharmacists, all reported positive patient feedback, while 7 reported improved job satisfaction. Among all 96 respondents, barriers reported included time constraints (49%) and a lack of appropriate reimbursement (43.8%).</div></div><div><h3>Conclusion</h3><div>Few HC-trained NC outpatient pharmacists are prescribing HCs. Addressing prescribing barriers would potentially expand the scope of this service and further innovate the outpatient pharmacy setting.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover","authors":"","doi":"10.1016/S1544-3191(24)00270-X","DOIUrl":"10.1016/S1544-3191(24)00270-X","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a pharmacist-led weight loss service to improve medication access and weight loss","authors":"","doi":"10.1016/j.japh.2024.102085","DOIUrl":"10.1016/j.japh.2024.102085","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a prevalent medical condition that can contribute to an increased risk of developing serious comorbidities, leading to an increase in hospitalizations, morbidity, and mortality. Many of these medical conditions can be improved with weight loss.</div></div><div><h3>Objectives</h3><div>This project was designed to improve weight loss outcomes and assess the utilization of services provided by clinical pharmacists for collaborative weight loss management.</div></div><div><h3>Methods</h3><div>The study design was a single-center, retrospective, and quality improvement study within 3 outpatient clinics at Tufts Medical Center. Patients referred to the pharmacist-led weight loss service from September 1 to October 31, 2022, and continued care for up to 6 months were included. Pharmacist services included selection of weight loss medication, assistance with medication access, device teaching and dose titration, lifestyle counseling, and follow-up. The primary outcome was percent weight loss from baseline.</div></div><div><h3>Results</h3><div>Seventy-nine patients were referred to the pharmacist-led weight loss service. Mean age of patients was 51 years (SD ±13). Sixty-one patients were female (77.2%). Median baseline weight was 105.5 kg (IQR 93.1 to 120.5 kg) and body mass index 38.1 kg/m² (IQR 33.9 to 43.5 kg/m²). The median percent weight loss from baseline through the end of the study duration was −8.0% (IQR -3.1 to −12.1%).</div></div><div><h3>Conclusion</h3><div>Pharmacists were able to effectively provide weight loss care through a pharmacist-led weight loss service by aiding in medication access, providing education on devices and lifestyle management, and engaging in frequent follow-up. Future directions of this study include expansion of the pharmacist-led weight loss service to other ambulatory care clinics within TMC.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140800109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reprint of: Four-factor prothrombin complex concentrate versus andexanet alfa for direct oral anticoagulant reversal","authors":"Soo Jin Koo,&nbsp;Yunus Hussain,&nbsp;Deborah Y. Booth,&nbsp;Payal Desai,&nbsp;Elly S. Oh,&nbsp;Jose Rios,&nbsp;Kristen Audley","doi":"10.1016/j.japh.2024.102156","DOIUrl":"10.1016/j.japh.2024.102156","url":null,"abstract":"<div><h3>Background</h3><div>Optimal reversal agent for direct oral anticoagulant (DOAC)–associated major bleeding has not been described. Before the approval of andexanet alfa (AA) in 2018, 4-factor prothrombin complex concentrate (4F-PCC) was recommended by major guidelines. Currently, AA is recommended as the first-line agent by most guidelines. With a paucity of literature comparing the 2 agents, there is clinical value in assessing hemostatic efficacy and safety of the 2 agents.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate hemostatic efficacy and safety of AA and 4F-PCC in all DOAC-associated major bleedings.</div></div><div><h3>Methods</h3><div>A multicenter, retrospective chart review was performed of adult subjects who were admitted for a DOAC-associated major bleeding and received 4F-PCC from February 2018 to May 2019 or AA from May 2019 to September 2021. Some of the exclusion criteria included not receiving a DOAC, receiving multiple reversal agents during the same hospitalization, receiving reversal for any nonmajor bleeding indication, and not receiving the full dose of a reversal agent. The primary outcome was hemostatic efficacy 24 hours after the end of the reversal agent administration. Secondary outcomes included time to administration, hospital mortality, length of stay, need for surgery, and need for additional blood product. Safety outcome was incidence of thrombotic events.</div></div><div><h3>Results</h3><div>There were 99 subjects included in the 4F-PCC group and 84 subjects in the AA group. Hemostatic efficacy was achieved in 69 subjects (69.7%) in the 4F-PCC group and 63 subjects (75%) in the AA group (<em>P</em> = 0.927). In-hospital mortality was seen in 20 subjects (20.2%) in the 4F-PCC group and 10 subjects (11.9%) in the AA group. Thrombotic events were seen in 7 subjects (7.1%) in the 4F-PCC group and 6 subjects (7.1%) in the AA group.</div></div><div><h3>Conclusions</h3><div>There were no significant differences in hemostatic efficacy, in-hospital mortality, and number of thrombotic events between 4F-PCC and AA.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reprint of: Pharmacist-led hypertension management in a minority patient population","authors":"Luis Trejo,&nbsp;Paige Carson,&nbsp;Nick Wilkins","doi":"10.1016/j.japh.2024.102183","DOIUrl":"10.1016/j.japh.2024.102183","url":null,"abstract":"<div><h3>Background</h3><div>Nearly half of adults in America have hypertension (HTN), and only approximately 1 in 4 adults has their blood pressure (BP) under control. High BP is more common in African Americans adults, and BP control is lower among minority adults. Pharmacist-led interventions for HTN have been shown to be effective in improving BP control and reducing the risk of cardiovascular events.</div></div><div><h3>Objective</h3><div>This study aimed to leverage electronic health record (EHR) data to improve BP control through pharmacist-led interventions.</div></div><div><h3>Methods</h3><div>This was a prospective, cohort study conducted at Atrium Health Concord Internal Medicine, a large suburban practice in Concord, North Carolina. Patients with uncontrolled HTN were identified using an EHR data tool. Patients were included if they were at least 18 years of age, had sustained uncontrolled HTN, and were of a minority race or ethnicity. The primary outcome was proportion of patients achieving a BP of &lt; 140/90 mm Hg in the intervention group compared with a control group. Secondary outcomes included mean change in BP from baseline, number and type of visits, and number and type of interventions.</div></div><div><h3>Results</h3><div>A total of 110 patients were enrolled in this study, 55 patients in each cohort. The baseline characteristics were generally well balanced between the 2 groups. The mean age was 62 years, and most patients were female and African American. For the primary outcome, 70.9% of the patients in the intervention group achieved a BP of &lt; 140/90 mm Hg compared with 32.7% of the patients in the control group (<em>P</em> &lt; 0.001). The most common intervention was lifestyle modifications, followed by BP monitoring technique education and medication adherence interventions.</div></div><div><h3>Conclusion</h3><div>In this study, pharmacist-led interventions resulted in clinically and statistically significant improvements in sustained uncontrolled HTN among minority populations.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to medication error reporting in a federally qualified health center","authors":"","doi":"10.1016/j.japh.2024.102079","DOIUrl":"10.1016/j.japh.2024.102079","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the National Coordinating Council for Medication Error Reporting and Prevention Categories of Errors health professionals are most likely to report and characterize what barriers to medication error reporting influence decisions to report and the extent they do so at a large federally qualified health center (FQHC).</div></div><div><h3>Design</h3><div>Prospective, cross-sectional, survey.</div></div><div><h3>Setting and participants</h3><div>A total of 161 medical professionals at a large FQHC clinic with a small pharmacy team.</div></div><div><h3>Outcome measures</h3><div>Survey responses to explore respondent understanding of medication error categories and the influence of barriers to medication error reporting on their decision to report.</div></div><div><h3>Results</h3><div>Thirty-six (22.4%) respondents completed the survey. Nearly 40% of respondents would not report a near-miss error and were influenced by workplace/environmental barriers significantly more than those who would report. Regardless of reporting experience or patient-care role, assessed barrier categories influence the decision to report similarly.</div></div><div><h3>Conclusion</h3><div>Near-miss medication errors are inconsistently reported. Efforts to improve reporting should emphasize addressing workplace/environmental barriers.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating social determinants of health into patient care workflows within a health-system specialty pharmacy","authors":"","doi":"10.1016/j.japh.2024.102101","DOIUrl":"10.1016/j.japh.2024.102101","url":null,"abstract":"<div><h3>Background</h3><div>The influence of adverse factors on social determinants of health (SDOH) and their impact on patient outcomes is widely recognized. Pharmacists, as accessible healthcare professionals, can play a pivotal role in identifying and addressing SDOH concerns. Health-system specialty pharmacies have consistently assisted patients in accessing expensive specialty medications and ensuring adherence to therapy. As such, they are uniquely positioned to address SDOH concerns of patients.</div></div><div><h3>Objective</h3><div>To assess the effectiveness of incorporating standardized SDOH screening and referral methods into the patient care workflows of a health-system specialty pharmacy.</div></div><div><h3>Practice description</h3><div>The University of North Carolina Health Care (UNC Health) Specialty and Home Delivery Pharmacy is a health-system owned specialty pharmacy serving patients in North Carolina, South Carolina, and Virginia. It holds accreditations from the Utilization Review Accreditation Commission and Accreditation Commission for Health Care.</div></div><div><h3>Practice innovation</h3><div>A standardized SDOH screening and referral method were integrated into patient care workflows of a health-system specialty pharmacy. If SDOH concerns were identified upon screening by a specialty pharmacist, patients were referred to an entity within the health-system responsible for connecting patients to local community resources to address their SDOH concerns.</div></div><div><h3>Evaluation methods</h3><div>The types of SDOH concerns, frequency of SDOH referrals, referral turnaround time, outcomes of the referrals, and patient demographics were evaluated to determine the impact of this project. Descriptive statistics were used to analyze results.</div></div><div><h3>Results</h3><div>Sixty-nine patients were included (female: n = 38, 55.1%; age (mean±SD: 48.9 ± 16.3). Eighty-seven SDOH concerns were reported, 54 patients (78.3%) were connected to local resources upon referral, and the average turnaround time of referrals was 2.2 business days.</div></div><div><h3>Conclusion</h3><div>The findings of this pilot study highlight the effectiveness of incorporating SDOH screening and referral methods into specialty pharmacy workflows. Specialty pharmacies can successfully identify and address nonmedical factors impacting patients.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities for de-escalation of aspirin therapy in patients with atrial fibrillation at high stroke risk receiving direct oral anticoagulants","authors":"","doi":"10.1016/j.japh.2024.102128","DOIUrl":"10.1016/j.japh.2024.102128","url":null,"abstract":"<div><h3>Objectives</h3><div>Atrial fibrillation (AF) is associated with increased risk of stroke that can be attenuated with newer anticoagulants, called direct oral anticoagulants (DOACs). Before the emergence of DOACs, warfarin or aspirin (ASA) was used for stroke prevention. Owing to the increased risk of bleed with concomitant anticoagulation therapy, populations that may benefit from ASA therapy are becoming limited. The primary objective of this study was to evaluate ASA utilization in an outpatient setting for patients with AF at high risk of stroke receiving a DOAC. The secondary objective was to evaluate what characteristics influence ASA use using a multivariate logistical regression model.</div></div><div><h3>Design</h3><div>This was a retrospective study conducted through electronic health record extraction between June 1, 2021, and May 31, 2022.</div></div><div><h3>Setting and participants</h3><div>Study sites included 219 outpatient Banner Health Facilities. A total of 5716 patients were included in the study.</div></div><div><h3>Outcome measures</h3><div>Patient characteristics and demographics, including CHA₂DS₂-VASc and HAS-BLED scores, were evaluated in adults 18 years and older with AF and an active DOAC prescription.</div></div><div><h3>Results</h3><div>There were 955 patients (16.7%) on ASA and 4761 patients (83.3%) not on ASA. Of the 955 patients on ASA, 33% (n = 315) did not have vascular disease. A total of 2289 patients had at least one vascular disease diagnosis. Of these patients, 28% (n = 640) were on ASA and 72% (n = 1649) were not on ASA. There were 142 patients with vascular disease who experienced a bleeding event with 36% of patients (n = 51) on ASA. Patients on ASA had a higher average CHA₂DS₂-VASc score (4.02 vs. 3.74) and HAS-BLED score (3.10 vs. 2.35) than patients not on ASA, respectively.</div></div><div><h3>Conclusion</h3><div>This study found approximately one-third of patients with documented ASA use had no documentation of vascular disease and an unclear pattern of use in patients with documented vascular disease, suggesting opportunities to de-escalate ASA in patients with AF on a DOAC.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141143909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reprint of: Self-identified prescriber tendencies in sodium-glucose cotransporter-2 inhibitor outpatient prescribing","authors":"Kristen Thompson,&nbsp;Brandi L. Bowers,&nbsp;Ashley M. Evans","doi":"10.1016/j.japh.2024.102177","DOIUrl":"10.1016/j.japh.2024.102177","url":null,"abstract":"<div><h3>Background</h3><div>Despite expanded indications and demonstrated cardiovascular and renal benefits, prescribing rates of sodium-glucose cotransporter-2 (SGLT-2) inhibitors are low.</div></div><div><h3>Objectives</h3><div>The study aimed to identify factors impacting prescriber decision-making when prescribing SGLT-2 inhibitors in the outpatient setting and identify differences across specialties in self-identified prescribing patterns.</div></div><div><h3>Methods</h3><div>An anonymous survey was administered electronically to prescribers in relevant specialties at a large community health system. Descriptive statistics were used to compile results, and subgroup comparisons were conducted utilizing Fisher’s exact test.</div></div><div><h3>Results</h3><div>Fifty-one prescribers completed the survey, representing a 25.2% response rate. The highest reported prescribing rates were for type 2 diabetes (92%), and the lowest for HFpEF (20%) and atherosclerotic cardiovascular disease risk reduction (16%). Prescribers without clinic-embedded pharmacist were more likely to report cost and insurance had at least a moderate effect on prescribing compared to prescribers with clinic-embedded pharmacists (95.3% vs. 62.5%, <em>P</em> = 0.0228) and less likely to report hemoglobin A1c less than 6.5% to have at least a moderate effect on prescribing (20.9% vs. 62.5%, <em>P</em> = 0.0317). Compared to specialty providers, primary care prescribers were more likely to report hemoglobin A1c over 9% had at least a moderate effect on prescribing (92.0% vs. 42.9%, <em>P</em> = 0.0082) and less likely to note history of urinary tract infection (22.2% vs. 85.7%, <em>P</em> = 0.0028), history of mycotic infection (38.9% vs. 100%, <em>P</em> = 0.0036), and sex (male: 5.6% vs. 42.9%, <em>P</em> = 0.0242; female: 8.0% vs. 42.9%, <em>P</em> = 0.0447) had at least a moderate effect on prescribing.</div></div><div><h3>Conclusion</h3><div>Prescribing hesitancies vary across specialty and when clinic-embedded pharmacists are present. Pharmacists may help improve SGLT-2 inhibitor prescribing rates and use of guideline-directed therapies. Pharmacists can target identified hesitancies through medication-access consultations, education regarding adverse effects, and expanded benefits of the class. Future studies should examine the impact of pharmacist intervention on SGLT-2 inhibitor prescribing rates.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reprint of: Efficacy and safety of apixaban compared to warfarin for nonvalvular atrial fibrillation in end-stage renal disease on hemodialysis","authors":"Mariah Moore,&nbsp;Kristina Vizcaino,&nbsp;Joseph A. Ewing,&nbsp;Madeline St. Ville","doi":"10.1016/j.japh.2024.102160","DOIUrl":"10.1016/j.japh.2024.102160","url":null,"abstract":"<div><h3>Background</h3><div>This study compared the efficacy and safety of apixaban and warfarin in patients with nonvalvular atrial fibrillation (NVAF) and end-stage renal disease (ESRD) on hemodialysis (HD). Apixaban decreased incidence of stroke and bleeding compared with warfarin in major clinical trials that excluded patients with severe renal dysfunction. Apixaban is no longer contraindicated in patients with ESRD on HD with NVAF based on pharmacokinetic studies. Limited clinical data exist for patients with ESRD on HD on apixaban.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed on patients with a diagnosis of NVAF and ESRD on HD who were prescribed apixaban or warfarin for stroke prevention in the years 2018 through 2019. Patients’ charts were reviewed for up to a 2-year period. Patients on renal replacement therapy other than HD, those using anticoagulation for reasons other than NVAF, patients with Child-Pugh Class C cirrhosis, and those with severe mitral valve stenosis were excluded. The primary outcome was emergency department visits or hospital admissions for ischemic stroke or transient ischemic attack. Secondary outcomes included major or minor bleeding and adverse effects.</div></div><div><h3>Results</h3><div>A total of 181 patients were screened; 110 patients met eligibility criteria and were included in the analysis. Four patients (7.5%) in the apixaban group and 6 patients (10.5%) in the warfarin group met the primary outcome of hospitalization or emergency department visit for stroke (<em>P</em> = 0.742). Symptomatic bleeding occurred in 39.6% of patients in the apixaban group and 36.8% in the warfarin group (<em>P</em> = 0.918). A trend in major bleeding occurred more often in the warfarin group, 52.4% versus 49.2% (<em>P</em> = 0.758).</div></div><div><h3>Conclusions</h3><div>There were no statistically significant differences in efficacy and safety outcomes between apixaban and warfarin in patients with NVAF and ESRD on HD in the intention-to-treat analysis of our study. Larger trials are needed to further analyze this patient population.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}