000145711 001__ 145711
000145711 005__ 20241122130823.0
000145711 0247_ $$2doi$$a10.3390/life14080986
000145711 0248_ $$2sideral$$a140690
000145711 037__ $$aART-2024-140690
000145711 041__ $$aeng
000145711 100__ $$aSáez-Benito, Ana M.
000145711 245__ $$aThe Role of the Pharmacist in a Patient’s Care for Individuals Undergoing Anticoagulant Therapy: A Case Report
000145711 260__ $$c2024
000145711 5060_ $$aAccess copy available to the general public$$fUnrestricted
000145711 5203_ $$aAchieving clinical effectiveness with vitamin K antagonists (VKAs) requires a Time in Therapeutic Range (TTR) above 65%. TTR is influenced by genetics (CYP2C9, VKORC1, CYP4F2), treatment adherence, and knowledge. The SAMe-TT2R2 algorithm is used to assess VKA treatment suitability. In this case report, SAMe-TT2R2 and pharmacogenetic analysis were used to improve oral anticoagulant management in a patient with poor control of INR. An 84-year-old, obese male with atrial fibrillation, undergoing acenocoumarol therapy, had a suboptimal TTR. An assessment with the SAMe-TT2R2 algorithm indicated a favorable profile for VKA use. An educational intervention on vitamin K-rich foods was conducted, and his physician was informed about the interaction between omeprazole and acenocoumarol, recommending its replacement with pantoprazole. This intervention was accepted by the physician and, three months post-intervention, the patient’s TTR improved to 100%. Poor adherence and limited knowledge contributed to treatment failures in patients with a good VKA profile. Pharmaceutical interventions significantly improved TTR management. Patients with favorable genetic and clinical profiles could achieve adequate control of their anticoagulant medication through these interventions. Predictive tools may help select patients who can effectively and safely use VKAs through pharmaceutical interventions.
000145711 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000145711 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000145711 700__ $$aSáez-Benito, Loreto
000145711 700__ $$aSalazar, María
000145711 700__ $$0(orcid)0000-0002-5494-6550$$aMagallón, Rosa$$uUniversidad de Zaragoza
000145711 700__ $$aBerenguer, Nuria
000145711 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000145711 773__ $$g14, 8 (2024), 986 [8 pp.]$$pLife (Basel)$$tLife$$x2075-1729
000145711 8564_ $$s240593$$uhttps://zaguan.unizar.es/record/145711/files/texto_completo.pdf$$yVersión publicada
000145711 8564_ $$s2685657$$uhttps://zaguan.unizar.es/record/145711/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000145711 909CO $$ooai:zaguan.unizar.es:145711$$particulos$$pdriver
000145711 951__ $$a2024-11-22-11:53:05
000145711 980__ $$aARTICLE