Outpatient Self‐Management of Warfarin Therapy: A Pilot Study

Abstract

Self-testing and adjusting of warfarin dosages by patients is an evolving strategy for management of oral anticoagulation. We performed this open, prospective, 3-month pilot study to assess the feasibility of conducting a large, randomized trial comparing self-managed with physician-managed anticoagulation. Ten competent patients with planned anticoagulation for at least 3 months were provided education on warfarin therapy and trained to use an individualized warfarin nomogram. International normalized ratios (INRs) were determined weekly for 12 weeks and reported with warfarin dosages to the investigator for the first 8 weeks only. Eight patients elected to use a home monitor (ProTime) to measure INRs. Patients maintained 76.5% (range 50-91.7%) of INRs within the target range. In 119 dosage adjustment decisions, there were only 3 errors (2.5%). No bleeding or thrombotic complications occurred. To confirm concordance, initial and final INRs were measured concurrently by the ProTime monitor and laboratory. The mean absolute difference for 16 paired INR determinations was 0.33 (range 0.02-0.9). All patients expressed satisfaction and a desire to continue with self-management. This pilot study provides support for conducting a prospective, large-scale, randomized trial.

Accuracy and clinical usefulness of the near‐patient testing CoaguChek S international normalised ratio monitor in rural medical practice

“…The patient visits their GP or pathology specimen collection centre to have a venous blood sample taken and the result is reported to the GP, who determines the need for dosage adjustments. The inability to make timely contact with the patient and the potential for misinterpretation of information conveyed by the GP has been shown to result in dosage errors 9–11 …”

Warfarin management after discharge from hospital: a qualitative analysis

“…[2][3][4][5] Fluctuating therapeutic responses necessitate more frequent International Normalized Ratio (INR) monitoring, 6 which may represent a significant burden for some patients. 7 Systemic factors may further complicate their anticoagulant therapy, [8][9][10][11] including poor discharge planning and insufficient communication between hospital-and community-based healthcare providers. 9,10 A multicentre trial has been proposed of a new, collaborative post-discharge warfarin management service that aims to address these problems.…”

Patient Self-Monitoring of Oral Anticoagulant Therapy

“…First, the duration of patient follow-up was 2 to 3 months in most studies, [33][34][35][36]38,[39][40][41] and only one study had a follow-up of more than 6 months. First, the duration of patient follow-up was 2 to 3 months in most studies, [33][34][35][36]38,[39][40][41] and only one study had a follow-up of more than 6 months.…”