Clinical Outcomes of a Pharmacy-Led Blood Factor Stewardship Program. (November 2017)

• Record Type: Journal Article
• Authors: Trueg, Anne O.; Lowe, Christopher; Kiel, Patrick J.
• Is Part Of: American journal of therapeutics. Volume 24:Number 6(2017)
• Publication Date: 2017-11
• Subjects: blood factors -- pharmacy stewardship -- recombinant factor 7 -- prothrombin complex concentrates; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.58
• DOI: 10.1097/MJT.0000000000000371
• Languages: English
• ISSNs: 1075-2765

Abstract

Abstract : To report the results of a pharmacist-directed blood factor stewardship program targeting off-label utilization designed to limit use to established organizational guidelines in high-risk populations. Prospective evaluation of recombinant factor VIIa and prothrombin complex concentrate orders beginning June 2013 through May 2014 and a matched retrospective cohort from June 2012 to May 2013. Matched cohorts were evaluated for 28-day mortality, change in international normalized ratio (INR), adverse events, concurrent blood product use, and cost savings. Forty-two orders for blood factor were ordered between June 2013 and May 2014, 70 orders in the year before (N = 112). Twenty eight–day mortality was not different between the cohorts: 53.9% versus 50% ( P = 0.77). Blood factor use with underlying liver failure and active bleeding was strongly associated with 28-day mortality: odds ratio (95% confidence interval), 2.9 (1.5–7.14) and 2.91 (0.01–2.91), respectively. Blood products dispensed increased over the year with plasma products the most significant (1 vs. 4 P = 0.004). All other clinical outcomes were nonsignificant. An annual cost savings of $375, 539 was achieved, primarily through a significant reduction in recombinant factor VIIa and avoidance in high-risk patients. Use of off-label blood factors can be controlled through a pharmacist-led stewardship program. Twenty eight–day mortality was not different between the 2 cohorts; however, identification of risk factors for death associated with blood factor use allows for restriction in high-risk populations, creates a discussion of futile care, and yields cost savings.