The Pharmacist’s Role in Bleeding Disorders

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Pharmacists are an important part of the care team for patients with bleeding disorders, providing services such as medication counseling and reconciliation.

March is Bleeding Disorders Awareness Month, which gives pharmacists the opportunity to advocate for and honor patients with bleeding disorders. Having a bleeding disorder can put a patient at risk of a hemorrhage and death.

There are approximately 3 million people nationwide who are affected by bleeding disorders.1 Approximately 30,000 people in the United States are thought to have hemophilia, whereas approximately 1 in every 100 people are affected by von Willebrand disease.1

One of the most important roles a pharmacist can play in the treatment of patients with bleeding disorders is counseling on the symptoms of bleeding, which include but are not limited to easy bruising, bleeding gums, heavy bleeding from small cuts, and nosebleeds. Making sure patients are aware of these signs can be lifesaving.

Another important role pharmacists can play in bleeding disorders is providing medication counseling and reconciliation for patients with bleeding disorders and individuals taking high bleed risk medications. Through medication counseling, pharmacists can warn these patients about the risk of using medications that may cause bleeding.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are found in most households and can pose the risk of bleeding when used inappropriately. Pharmacists can counsel patients on how to safely use NSAIDs and identify which patients should not use them.

In 2018, a study was done on the effect of a pharmacist-driven monitoring program and electronic health record on bleeding log completeness, documentation in an electronic health record (EHR) and pharmacist-driven clinical interventions.2 During this pharmacist-driven monitoring program, a pharmacist was placed in a hemophilia treatment center (HTC) 4 hours per week to provide patient education and help build interdisciplinary relationships with the care team.

While bleeding logs have been the standard of care for determining adherence in patients with bleeding disorders, the study showed that implementation of this program improved bleeding log completeness and documentation in the EHR among the HTC patients with bleeding disorders.2

Another study developed by pharmacists focused on a Hemophilia Management Program. This program was designed to improve care, reduce spending, and expand clinical pharmacy services.3

In total, implementation of the Hemophilia Management Program resulted in a net savings of 2.7 million for the fiscal year 2017. Some of this cost savings is attributed to the pharmacist’s early identification of patients needing clotting factors and use of the 340B Drug Pricing Program, which also effectively reduced the need for blood transfusions per patient.3

Pharmacists can close the gap in care for patients with high-risk diseases, leading to better outcomes, patient education, and cost savings. As a pharmacist, whether in the clinical or the community setting, take the time to educate yourself and your patients on the risks of bleeding and early recognition of a possible bleed.

References

1. Bleeding Disorders. American Society of Hematology https://www.hematology.org/education/patients/bleeding-disorders Accessed February 7, 2022.

2. Shay B, Kennerly-Shah J, Neidecker M, et al. Effect of a Pharmacist-Driven Monitoring Program and Electronic Health Record on Bleeding Log Completeness and Documentation. J Manag Care Spec Pharm. 2018;24(10):1034-1039. doi:10.18553/jmcp.2018.24.10.1034

3. Slocum, GW, Peksa, GD, Webb, TA, Lat, I. Implementation of a hemophilia management program improves clinical outcomes. J Am Coll Clin Pharm. 2019; 2: 236– 242. https://doi.org/10.1002/jac5.1061