Pharmacist-led anticoagulation care in cancer: Associations with bleeding and VTE recurrence

Abstract

Objectives

Venous thromboembolism (VTE) is a major complication in cancer patients, resulting in heightened mortality and morbidity. Managing recurrence of VTE or risk of bleeding is a major challenge among cancer patients receiving anticoagulants. Therefore, this study assesses the effects of pharmacist-led interventions on the occurrence of either bleeding or recurrent VTE among cancer patients.

Methods

This retrospective cross-sectional study analyzed data from a tertiary care cancer hospital in Pakistan, collected from 2019 to 2023. The study included cancer patients aged ≥18 years diagnosed with VTE. The primary exposure variable was pharmacist-led interventions, and the primary outcome was a composite endpoint defined as occurrence of wither bleeding or recurrent VTE. Patient's demographics, cancer type, comorbidities, and type of anticoagulants were controlled as covariates. The chi-square test and t-test were used in bivariate analyses, at a significance level of p < 0.05. A multivariate logistic regression model was used to determine the association between pharmacist-led interventions and the risk of bleeding or recurrent VTE.

Results

Of the 210 individuals, 34.3% (n = 72) experienced the composite outcome of bleeding or recurrent VTE. Patients on subcutaneous anticoagulants had a markedly greater incidence of events in contrast to those on oral anticoagulants (77.8% vs. 22.2% respectively, p = 0.017). Metastatic cancer (80.6% vs. 52.1%, p = 0.0001) and surgical procedures (70.8% vs.47.2%, p = 0.0014) were significant predictors of the composite outcome. Interventions guided by pharmacists markedly decreased the likelihood of the composite outcome (aOR = 0.44, 95% CI: 0.20–0.97) by the optimization of dose, monitoring, and patient education.

Conclusion

Pharmacist-led interventions markedly enhance outcomes among cancer patients receiving anticoagulant treatment by decreasing the risk of outcome of bleeding or recurrent VTE. The findings highlight the necessity of including pharmacists into multidisciplinary cancer care teams. Subsequent research should investigate these therapies in more diverse groups to enhance the validation of their effects.