Effect of Pharmaceutical Care Combined with Remote Counseling Using Line Official Account Application for Prevention Adverse Drug Reaction from Warfarin Drug Interaction at Sukhothai Hospital.

Abstract

The incidence of adverse drug reactions (ADR) among patients receiving warfarin at Sukhothai Hospital increased from 12 cases in 2020 to 46 cases in 2024. The primary cause was identified as drug interactions between warfarin and concomitant medication. Therefore, the system was developed to maintain international normalized ratio (INR) within the target range throughout the period of drug interaction and increase time in therapeutic range (TTR) in addition continuous patient education regarding warfarin therapy was provided. To proposed. To prevent and reduce the severity of warfarin related ADRs. This study aimed to assess the impact of pharmaceutical care combined with remote counseling using Line Official Account application on INR level, warfarin related ADR, TTR and knowledge were compared between the intervention group, consisting of patients who received pharmaceutical care combined with remote counseling, and control group, consisting of patients who received pharmaceutical care alone. This study was a randomized controlled trial involving 50 participants, allocated to either the intervention or control group. The sample included outpatients who were prescribed warfarin and had documented drug interactions. The baseline characteristics of the two groups were not significantly different (p>0.005) except hypertension comorbidity patients were statistically difference (p=0.039). At three weeks following the drug interaction the mean INR value outside the target range was significantly higher in control group compared to the intervention group (4.63±2.59 vs 2.56±0.38, p<0.001) and the proportion of patients with therapeutic INR was statistically significantly lower than intervention group (8% vs 88%; p<0.001). The mean TTR value was significantly lower than intervention group (29.79±29.47 vs 57.42±33.89; p<0.001) and the proportion of patients TTR>65% statistically significantly remained lower than intervention group (14% vs 46%; p<0.001). Average score of knowledge was significantly lower than intervention group (12.78±1.56 vs 13.68±1.20; p=0.02). The proportion of minor bleeding in the control groups was higher than in the intervention group but was not significant difference (16% vs 6%; p=0.110). The proportion of major bleed in the control group was higher than in the intervention group but was not significant difference (4% vs 0; p=0.495) (5.33 events/100 patient-month). No thromboembolic event was found in two groups. Conclusion: These results indicated pharmaceutical care with remote counseling could effectively improve warfarin therapy to target higher than pharmaceutical care only, enhance warfarin knowledge, protect and reduce complications of warfarin use.