Maywood, IL—Having a pharmacist present makes a significant difference for patients taking blood-thinners who have life-threatening bleeding when they come to emergency departments (EDs).

That’s according to a study in the Journal of Emergency Medicine. Loyola Medicine researchers point to the importance of reversal of anticoagulation with four-factor prothrombin complex concentrate (4F-PCC) but add that the optimal timing to 4F-PCC administration and whether quicker administration improves hemostasis has been unknown.

Specifically, the study team was trying to determine if pharmacist presence is predictive of faster time to 4F-PCC.

The retrospective cohort study included patients receiving 4F-PCC for life-threatening bleeding or an urgent procedure in the ED from 2014 to 2018.

Researchers compared patients with pharmacists at bedside, i.e., the PharmD group, to physician teams alone (control group). Defined as the primary outcome was time from ED presentation to 4F-PCC administration.

After evaluation of 252,116 patients (46%) were included, with 50 in the PharmD group and 66 in the control group. The study explains that most patients presented on warfarin (68.1%), and of the life-threatening bleeds (94%), intracranial hemorrhage was most common (67.2%).

Results indicated that median time to 4F-PCC administration was significantly shorter in the PharmD group (66.5 vs. 206.5 min, P <.001).

In fact, the study team emphasizes that pharmacist presence at bedside was the only factor independently associated with reduction in time to 4F-PCC (beta coefficient -63.5 min, 95% CI, -249.4 to -77.7). No difference in hemostasis or mortality was documented, but patients in the PharmD group had a shorter ICU length of stay (LOS) (2 vs. 5 days, P <.01) and hospital LOS (5.5 vs. 8 days, P = .02).

“A pharmacist at the bedside of patients who present to the ED with life-threatening bleeding or need for emergent procedure decreased time to 4F-PCC administration by 140 min, even after accounting for confounders,” study authors conclude. “Faster time to 4F-PCC was associated with significantly shorter intensive care unit and hospital LOS.”

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