Quality of anticoagulation care in patients discharged from a pharmacist-managed anticoagulation clinic after stabilization of warfarin therapy.

Study Objective: To determine if transitioning patients from a pharmacist- managed anticoagulation clinic after stabilization of warfarin therapy to physician-managed care alters the quality of anticoagulation care.

Design: Retrospective medical record review.

Setting: Pharmacist-managed, urban academic medical center-based outpatient anticoagulation clinic.

Successful anticoagulation and continuation of tramadol therapy in the setting of a tramadol-warfarin interaction.

Tramadol is a commonly used synthetic opioid with the advantage of lowering the potential for dependence. Two reports of a tramadol-warfarin drug interaction have been published, and the current product insert states that increased international normalized ratios (INRs) with concomitant tramadol-warfarin use have been reported. We report a tramadol-warfarin drug interaction that caused a supratherapeutic INR in a 65-year-old man in previously stable condition who was being treated at our anticoagulation clinic.

Caring for patients with chronic kidney disease: a joint opinion of the ambulatory care and the nephrology practice and research networks of the American College of Clinical Pharmacy.

An increasing number of patients are developing chronic kidney disease (CKD). Appropriate care for patients with CKD must occur in the earliest stages, preferably before CKD progresses to more severe stages. Therefore, recognition and treatment of CKD and its associated complications must occur in primary care settings.