Impacto do cuidado farmacêutico na monitorização laboratorial do RNI de usuários de antagonistas de vitamina k: uma revisão integrativa.

Abstract

Vitamin K antagonists are drugs used in therapy to promote anticoagulation. These therapeutic agents are used in various diseases, such as atrial fibrillation, deep vein thrombosis and heart valve replacement, with the aim of reducing coagulation activity in these clinical conditions. However, these drugs are considered high-alert drugs, as they have a narrow therapeutic window, requiring monitoring of users of these therapeutic agents using the International Normalized Ratio (INR), and the pharmacist, through philosophical precepts of Pharmaceutical Care, can have a positive impact on the monitoring of these individuals. Therefore, the objective of this research was to evaluate the laboratory impact of Pharmaceutical Care in monitoring users of vitamin K antagonists. An integrative literature review was carried out, consulting the following databases: Central, Embase, Pubmed, Scopus, ScienceDirect, and Web of Science, using specific search strategies for each database, in the period from November 2024 to January 2025. Eleven scientific articles were included in this study, five randomized clinical trials, three prospective cohorts and three retrospective cohorts, with a total of 8866 participants, the majority male, with an average age ranging from 48.8 to 74.4 years. Furthermore, atrial fibrillation, deep vein thrombosis/pulmonary embolism, and stroke were the main diseases and clinical indications identified in the studies. Nevertheless, in general, clinical pharmacy presented better results in INR monitoring through higher percentages within the therapeutic range of INR, and lower risk of adverse events related to therapy with vitamin K antagonists when health education, identification of drug interactions, resolution of drug-related problems (DRPs), and development of protocols with other health professionals and pharmaceutical care work processes were included. Therefore, it is concluded that there is positive scientific evidence for the clinical practice of pharmacists, as a new therapeutic approach for INR monitoring in users of vitamin K antagonists, resulting in a lower risk of adverse events related to anticoagulation. However, it is necessary to carry out new studies such as systematic reviews and meta-analyses to obtain better robustness of the scientific evidence, in addition to carrying out pharmacoeconomic studies in order to understand its cost-benefit.