OBJECTIVE To explore the role of clinical pharmacists in utilizing the consultation pathway and decision-making methods based on medication therapy problems for antithrombotic drugs in promoting individualized antithrombotic medication therapy during antithrombotic pharmaceutical consultations.

METHODS Based on the medication therapy management(MTM) and combined with the characteristics of thrombotic diseases, an medicine related problem(MRP)-oriented anticoagulation pharmacy consultation pathway and decision-making system was established. An anticoagulation consultation evaluation and follow-up form was developed to structurally collect data on anticoagulation therapy evaluation and effectiveness assessment. A quality assessment and effectiveness evaluation were conducted on 322 anticoagulation consultations using this method from May 2020 to December 2023.

RESULTS The top three MRPs were the need for increased anticoagulation medication therapy(31.64%), unnecessary anticoagulation medication therapy(22.67%), low dose of anticoagulation medication therapy(9.94%). At the same time, 26.71% of the patients had ≥2 types of MRPs. The overall clinical adoption rate of consultation opinions from anticoagulation pharmacists was as high as 91.31%. After consultation and intervention by anticoagulation pharmacists, 85.09% of thrombotic diseases improved or were cured upon discharge, with thrombotic adverse events and bleeding adverse events accounting for only 0.62% and 4.97%, respectively. Only one case(0.31%) of the patient experienced both thrombotic events and hemorrhagic events. Through multivariate logistic regression analysis, Charlson comorbidity index score, consultation adoption status, high risk of bleeding, and high risk of thrombosis emerged as critical determinants impacting patient outcomes.

CONCLUSION The antithrombotic pharmacy consultation pathway and decision-making method oriented towards (MTM-MRPs) developed in this study can systematically and accurately identify and solve MRPs in antithrombotic pharmacy consultations, efficiently provide individualized antithrombotic drug treatment consultation suggestions, and improve the quality, safety and effectiveness of antithrombotic pharmacy consultations. It provides a practical model for clinical pharmacists and the construction of a high-quality antithrombotic pharmaceutical service system.