Key result
Warfarin dosing by anticoagulant clinics in haemodialysis units achieved the best outcomes for INR targets (up to 63% meeting standards) with the least frequency of blood sampling.
Why the study?
Does service design, such as dosing by anticoagulant clinics, improve the achievement of warfarin therapeutic targets in haemodialysis patients?
Observational
Yes
Does service design, such as dosing by anticoagulant clinics, improve the achievement of warfarin therapeutic targets in haemodialysis patients?
Service design and monitoring pathways, particularly dosing by specialized anticoagulant clinics, are crucial for achieving warfarin therapeutic targets safely in haemodialysis patients.
May support clinic-based warfarin dosing in haemodialysis; leaves open need for RCTs before practice change.
BACKGROUND: We evaluated current oral anticoagulant management at our main dialysis unit and three satellite units against British Haematology Society (BHS) standards. These standards include patients meeting their target INR +/- 0.5 INR units for 60% of the time with an appropriate frequency of monitoring. METHODS: Data were collected on anticoagulant prescribing and monitoring over one month. RESULTS: None of the four haemodialysis centres were able to achieve BHS standards for all patients. There was wide variability in monitoring frequency, some patients had 13 INRs and up to 10 dose changes. Satellite C had the most patients (63%) meeting BHS target. Satellite A and B both had 50% of patients meeting target. However, Satellite A, where all patients were dosed by anticoagulant clinic, had the least frequent blood sampling and no patients exceeded the therapeutic INR. CONCLUSION: Units that employed dosing by anticoagulant clinics demonstrated best outcome for INR target with the least frequency of sampling. Service design set up and monitoring pathways play a crucial role in achieving warfarin therapeutic targets in haemodialysis units.
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Parker et al. (2012) conducted an observational in Haemodialysis patients on warfarin. Dosing by anticoagulant clinics vs. Other dosing methods was evaluated on Meeting British Haematology Society standards (target INR +/- 0.5 INR units for 60% of the time). Warfarin dosing by anticoagulant clinics in haemodialysis units achieved the best outcomes for INR targets (up to 63% meeting standards) with the least frequency of blood sampling.
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