There are some newer anticoagulation drugs which are called as dabigatran, rivaroxaban, and apixaban. These do not need monitoring or dose adjustment and they are as effective as warfarin or Warfarin alternative at preventing blood clots.
Background: Point-of-care international normalized ratio (INR) monitoring devices simplify warfarin management by allowing selected patients to monitor their own therapy in their homes. Patient self-testing (PST) has been shown to improve the clinical outcomes of warfarin therapy compared to usual care.
Objective: To compare management of warfarin therapy using PST combined with online supervision by physicians via a custom system with usual warfarin management, which involved laboratory testing and physician dosing.
Methods: Interested patients were recruited via community pharmacies to participate in a warfarin PST training program. Participants were required to have a long-term indication for warfarin, have been taking warfarin for at least 6 months, and have Internet access in their home. The training involved two sessions covering theoretical aspects of warfarin therapy, use of the CoaguChek XS, and the study website. Following training, patients monitored their INR once weekly for up to 3 months. Patients and physicians utilized a secure website to communicate INR values, dosage recommendations, and clinical incidents. Physicians provided a 6-12 month history of INR results for comparison with study results. The percentage of time spent within the therapeutic INR range (TTR) was the primary outcome, with participants acting as their own historical controls. The percentage of INR tests in range and participant satisfaction were secondary outcomes.
Results: Sixteen patients completed training requirements. The mean age of participants was 69.8 (SD 10.1) years. TTR improved significantly from 66.4% to 78.4% during PST (P=.01), and the number of tests within the target range also improved significantly (from 66.0% at prior to the study to 75.9% during PST; P=.04). Patients and physicians expressed a high degree of satisfaction with the monitoring strategy and online system.
Conclusions: PST supported by an online system for supervision was associated with improved INR control compared to usual care in a small group of elderly patients. Further research is warranted to investigate the clinical outcomes and cost-effectiveness of online systems to support patients monitoring medications and chronic conditions in the home.
Patients prescribed warfarin are required to undergo routine blood tests to make sure the dose is correct. The following information explains the options available to patients for this type of routine blood testing, with emphasis on the option of at-home or patient self-testing.
Millions of people today are prescribed warfarin, and, despite the recent introduction of new oral anticoagulant medications, millions of people will continue to depend on warfarin for many years to come. Certain diseases or conditions, for example, prevent some people from using the newer oral anticoagulation therapies, so warfarin will continue to be an important therapeutic option.
The specific blood test used to measure the time it takes for blood to clot is called a prothrombin time test, or protime (PT). The PT is reported as the International Normalized Ratio (INR). The INR is a calculation based on results of a PT test and is used to monitor individuals who are being treated with the anticoagulation medication warfarin.
Some patients who use a POC device to check their INR at home may be instructed to adjust their warfarin dosage on their own. While this type of anticoagulation management has gained popularity in some European countries, it has not yet been widely embraced by U.S. health professionals or healthcare systems. However, experts believe that it will become more popular in the U.S. in the future. Always take your anticoagulation medications as prescribed, and consult with your doctor before making any changes to your prescribed treatment.
Research shows that, compared to standard INR monitoring, patients who self-monitor their warfarin therapy have better therapeutic experiences without an increase in side effects or harmful outcomes. In fact, several studies have shown that individuals who monitor their own INR have slightly less bleeding and clotting complications, and that they are more often in the target INR range, meaning that their anticoagulation therapy is better controlled.
INR values obtained with the finger stick home testing devices typically correlate well and are able to be replicated with INR results that are determined from venous blood draws, making them reliable. In fact, recent research indicates that self-testing may produce better outcomes for patients who are eligible to participate.It is important to note that POC instruments are unreliable in about one-third of patients who take warfarin and who are also affected by the clotting disorder antiphospholipid antibody syndrome (APLS or APS). In these patients, the POC devices give INR readings that are too high, or the instruments can report an error message. If you have APS, your INR levels should be checked via a vein draw in a laboratory setting and compared with a POC reading from a finger stick. Only if both values correlate, may it be acceptable for APS patients to use a POC device. APS patients should discuss their testing options with their healthcare providers.
Many insurance plans, including Medicaid and Medicare, do often cover the cost of home INR testing for some conditions that require anticoagulation therapy.Eligibility for INR self-testing under Medicare and most private insurance plans require that you be diagnosed with atrial fibrillation, deep vein thrombosis or pulmonary embolism, have a mechanical heart valve, or be at increased risk for the development of a dangerous blood clot. In addition, you have to demonstrate that you have been taking warfarin successfully for at least 90 days, be able to perform the test at home on your own or with the assistance of a caregiver, undergo training for the use of the device and demonstrate that you know how to use the device correctly.
If you are on warfarin and are interested in checking your INR with a home monitoring device, you should discuss your options with your healthcare provider. Your healthcare provider will need to 1) write a prescription for the device 2) be available to instruct you in dosage adjustments and 3) remain medically responsible for your anticoagulation management.Once a prescription has been written that directs you to self-test your INR, you can speak with your doctor or your insurance company for guidance about where to obtain your device and how to get started.
Advanced Cardio Services is an IDTF that provides a home anticoagulation testing and monitoring service to help reduce the risk of potential complications associated with long-term warfarin therapy or out-of-range INR levels. You can learn more about INR self-testing through this service by reading the frequently asked questions that appear on their website here.
Medical experts stress the importance of doing your self-testing in consultation with your doctor, working in conjunction with an IDTF. While the cost of testing through an IDTF varies depending on your insurance coverage, most plans typically cover the services provided by an IDTF, including patient training with the device, providing the equipment and supplies for monitoring your INR, and reporting your test results to your doctor.However, you can purchase PT/INR devices for home testing on your own. For example, on the Internet the devices can be acquired from some online medical supply companies and from more widely recognized online retailers, such as Amazon. The price for the devices ranges widely, from $600 to more than $3,000, and the price for test strips ranges from $7 to $18 per test. You should note that in some cases the online retailers of these devices have not been authorized by the device manufacturer to distribute the device. Also, your health insurance may not cover the cost of the device you buy on your own through the Internet.
If you purchase a POC PT/INR testing device independently from an online retailer or other retail source, you will not be able to use that device in connection with an IDTF that provides the crucial services you and your physician will likely require. When you enroll with an IDTF, you will be provided with the equipment and the ongoing supplies you need for testing. One of the important benefits of using an IDTF is that these companies will work with your physician to obtain your prescription for self-testing and contact your insurance provider to discuss your coverage status based on your insurance plan design. In addition, the IDTF companies that provide these services can ensure that the device you are using is safe and in good working condition, that you are notified promptly if any product updates or recalls occur, and that any company warranties are honored. These services will not be available if you purchase the device on your own.
It is important to work together with your healthcare provider to come up with the best plan to monitor your INR and adjust your warfarin dose, as needed. Some healthcare providers may be hesitant to switch to an at-home monitoring device for a variety of reasons, including the cost of the device, hesitancy about giving medical instructions over the phone, and concerns about lack of good communication between patients and themselves.Discuss the pros and cons of using a POC device with your healthcare provider to help determine whether it is the right option for you.
Before taking COUMADIN, tell your doctor about:Any allergies to this medication or any other substancesYour medical history, especially of: blood disorders (such as anemia, hemophilia), bleeding problems (such as bleeding of the stomach/intestines, bleeding in the brain), blood vessel disorders (such as aneurysms), recent major injury/surgery, liver disease, alcohol use, mental/mood disorders (including memory problems), frequent falls/injuriesAny planned surgery or any medical/dental proceduresAny prescription drugs, nonprescription drugs, and herbal products you may be using.You should not take COUMADIN if you have:hemophilia or any bleeding disorder that is inherited or caused by diseasea blood cell disorder such as anemia or a low level of platelets in your bloodblood in your urine or stools, or if you have been coughing up bloodan infection of the lining of your heart (also called bacterial endocarditis)stomach or intestinal bleeding or ulcerrecent head injury, aneurysm, or bleeding in the brainif you have recently had or will soon have any type of surgery if you undergo a spinal tap or receive spinal anesthesia (epidural)Other important information patient should be aware of:Older adults may be at greater risk for bleeding while using COUMADINDo not use this medication during pregnancy because it can seriously (possibly fatal) harm to an unborn baby. Very small amounts of this medication may pass into breast milk but is unlikely to harm a nursing infant. Do not take a double dose of COUMADIN or take it together with other products that contain warfarin or coumarin. 59ce067264