Abstract

Objective: Evaluate the pharmacotherapy of patients with anticoagulant therapy in internal medicine at the Hospital Universidad del Norte through medication therapy management using the DADER methodology. Materials and methods: Quasi-experimental and ampispective descriptive study. It included a retrospective study population called reference group who were 78 anticoagulant therapy patients hospitalized in three months of 2022, which were performed a sociodemographic, clinical, pharmacological characterization and analysis of drug-related problems (DRP) and negative outcomes associated with drugs (NOM), to determine the approach of the patient in medication therapy management who were hospitalized patients in three months of 2023 corresponding to the group attended with 66 patients. The activities performed were based on the DADER methodology. Statistical analysis of the data was performed with the STATGRAPHICS Centurion XVI version 16.1.03 program, for quantitative and qualitative data. Results: In the group attended the DRP and the most frequent NOM was drug-drug interactions, and quantitative insecurity respectively, while in the reference group the most frequent DRP was inadequate dose, regimen and/or duration, followed by the NOM quantitative ineffectiveness. The drug associated with the occurrence of NOMs was Warfarin with 57.15% in the reference group, and with 62.5% in the attended group. Finally, through tests of independence (CHI2) it was shown that: Patients with DRP have 8.83 probability of presenting a pharmaceutical intervention. Conclusion: It was possible to perform the pharmaco therapeutic evaluation, and the need to approach the patient with oral anticoagulants was identified, specifically with Warfarin due to the labiality of the INR, because, according to our study, the INR of 100% of the patients with Warfarin in the group attended was outside the therapeutic window, and for the reference group it was 78.44% respectively. It was also identified that patients with atrial fibrillation should be a target population for medication therapy management Limitations: Lack of recognition from health professionals about the role of the pharmacist in the evaluation of pharmacological treatment, likewise the application of Dader methodology in the hospital setting, and delays in Colombia healthcare system in an ambulatory care for dose adjustment and INR control

Keywords

drug therapy management, anticoagulant drug, pharmaceutical care, drugdrug interactions