A new therapeutic position statement released by the American Society of Health-System Pharmacists (ASHP) underscores the important role pharmacists have in monitoring and educating patients with chronic atrial fibrillation on the safe use of warfarin or aspirin to prevent stroke. The statement also provides new information that more strongly supports the routine use of the medicines in patients with atrial fibrillation, a condition that is characterized by unusual heart rhythms.

The statement, authored by Edith A. Nutescu, Pharm.D, clinical associate professor at the University of Illinois at Chicago College of Pharmacy, comes at a time when the number of people in the U.S. with atrial fibrillation, which is a strong risk factor for stroke, is rising sharply. The population in the U.S. with atrial fibrillation is expected to soar from nearly 2.5 million currently to 5.6 million in 2050. Fueling that growth is the graying baby boomer population, in whom atrial fibrillation is more common. This growth leads to a larger healthcare burden: the statement notes that hospitalization rates attributed to atrial fibrillation have doubled and tripled in recent years, and according to the American Heart Association, the overall costs associated with strokes in 2006 were $57.9 billion.

Appearing in the Nov. 1, 2007 issue of the American Journal of Health-System Pharmacy (Am J Health-Syst Pharm 2007 64: 2281-2291), the statement is an update of a previous statement on atrial fibrillation ASHP completed in 1998. The new document includes ASHP's support for recommendations by the American College of Chest Physicians, which say that warfarin or aspirin use in patients with atrial fibrillation reduces disease and death associated with stroke. The latest ASHP statement also documents studies that show the safety and optimal intensity of warfarin or aspirin use to prevent strokes.

The statement encourages the use of warfarin to reduce stroke for those patients for whom it can be administered safely. Prescribers are concerned that complications from bleeding can result from antithrombotic therapy, which uses warfarin or aspirin. ASHP believes that practitioners should have a thorough understanding of the risk and benefits of this therapy. The Society also believes pharmacists should work actively with other healthcare providers to optimize the therapy and provide adequate patient education and monitoring.

Accompanying the latest statement in AJHP is a commentary by William E. Dager, Pharm.D., on how pharmacists can play a key role in improving patient care by initiating warfarin or aspirin to fight stroke in the inpatient, transitional or outpatient settings. Dager cautions clinicians managing patients who receive medicine that prevents blood clotting to consider the presence of drug interactions and multiple diseases occurring in patients. He also says the statement provides a concise and practical overview of the guidelines for use of antithrombotic therapy to prevent stroke.

Therapeutic position statements respond to therapeutic issues of concern to healthcare consumers and pharmacists. The ASHP Council on Therapeutics, an advisory group that focuses on societal drug use and therapeutic issues, oversees the documents.

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About ASHP

For more than 60 years, ASHP has helped pharmacists who practice in hospitals and health systems improve medication use and enhance patient safety. The Society's 30,000 members include pharmacists and pharmacy technicians who practice in inpatient, outpatient, home-care, and long-term-care settings, as well as pharmacy students. For more information about the wide array of ASHP activities and the many ways in which pharmacists help people make the best use of medicines, visit ASHP's Web site, http://www.ashp.org, or its consumer Web site, http://www.SafeMedication.com.