Key result
Implementation of a standardized warfarin monitoring program significantly decreased the severe warfarin adverse drug reaction rate from 3.8% at baseline to 0.98% over a 5-year period.
Why the study?
While warfarin is widely prescribed to prevent thromboembolic disorders, the risk of adverse drug reactions poses a serious concern, motivating an evaluation of standardized provider management to decrease these events.
Does standardized warfarin monitoring and management decrease severe adverse drug reactions in patients prescribed warfarin?
Observational (n=10,922)
No
Does standardized warfarin monitoring and management decrease severe adverse drug reactions in patients prescribed warfarin?
Absolute Event Rate: 0.98% vs 3.8%
p-value: p=<0.0001
Implementation of a standardized, multidisciplinary warfarin monitoring program significantly reduced severe adverse drug reactions and associated healthcare costs.
Associated with fewer warfarin ADRs in this cohort; leaves open need for RCTs to confirm causality and guide practice.
BACKGROUND: While warfarin is the most commonly prescribed medication to prevent thromboembolic disorders, the risk of adverse drug reactions (ADR) poses a serious concern. This prospective study evaluated how primary care providers (PCP) and cardiologists at our Institution managed patients treated with warfarin with the goal of decreasing the number of warfarin ADRs. METHODS: A multidisciplinary anticoagulation task force was established at our Institution in 2014 to standardize warfarin monitoring and management. Between 2013 and 2017, we analyzed patients who were prescribed warfarin by their PCP or cardiologist upon hospital discharge and in the ambulatory setting to determine the international normalized ratio (INR) within 5, 10, and 30 days after discharge, time in therapeutic range (TTR), number of severe warfarin ADRs, and total and average cost reduction of all severe warfarin ADRs to determine whether there was an organizational cost savings following the implementation of standardized warfarin care. RESULTS: The warfarin ADR rate significantly decreased over the 5-year period, from 3.8 to 0.98% (p < 0.0001). The proportion of warfarin prescriptions out of all anticoagulants significantly decreased, from 72.2 to 42.1% (p < 0.001). The proportion of individuals who received an INR at 5, 10, and 30 days after hospital discharge compared to the total number of patients prescribed warfarin significantly increased (p < 0.001). The total cost of severe warfarin ADRs decreased by 57.6% between 2013 and 2017. CONCLUSIONS: This study serves as a model to reduce the number of severe warfarin ADRs by the following tactics: (1) educating PCPs and cardiologists about evidence-based guidelines for warfarin management, (2) increasing the use of our Institution's electronic warfarin module, and (3) enhancing patient compliance with obtaining INR.
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Shields et al. (2019) conducted an observational in Patients prescribed warfarin (n=10,922). Standardized warfarin monitoring program vs. Baseline (prior to program implementation) was evaluated on Severe warfarin adverse drug reactions (ADR rate) (p=<0.0001). Implementation of a standardized warfarin monitoring program significantly decreased the severe warfarin adverse drug reaction rate from 3.8% at baseline to 0.98% over a 5-year period.
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