Key result
A home monitoring programme for patients initiated on warfarin significantly reduced bleeding events at 3 months compared to usual care (15% vs 36%, P<0.01).
Why the study?
Does home monitoring with pharmacist visits and point-of-care INR testing improve anticoagulant control and reduce bleeding events in patients newly initiated on warfarin?
RCT (n=128)
Open-label
randomized
No
Does home monitoring with pharmacist visits and point-of-care INR testing improve anticoagulant control and reduce bleeding events in patients newly initiated on warfarin?
Absolute Event Rate: 15% vs 36%
p-value: p=< 0.01
A home-based follow-up program for patients newly initiated on warfarin significantly improved early INR control and reduced hemorrhagic complications at 3 months.
Supports home monitoring for new warfarin initiations to reduce early bleeding; extends RCT evidence for pharmacist-led point-of-care INR programs.
OBJECTIVES: A number of studies have reported that the risk of bleeding associated with warfarin is highest early in the course of therapy. This study examined the effect of a programme focused on the transition of newly anticoagulated patients from hospital to the community. DESIGN: Open-label randomized controlled trial. SETTING: Home-based follow-up of patients discharged from acute care hospital in southern Tasmania, Australia. SUBJECTS: A total of 128 patients initiated on warfarin in hospital and subsequently discharged to general practitioner (GP) care were enrolled in the study. Sixty were randomized to home monitoring (HM) and 68 received usual care (UC). INTERVENTIONS: HM patients received a home-visit by the project pharmacist and point-of-care international normalized ratio (INR) testing on alternate days on 4 occasions, with the initial visit two days after discharge. The UC group was solely managed by the GP and only received a visit 8 days after discharge to determine anticoagulant control. RESULTS: At discharge, 42% of the HM group and 45% of the UC group had a therapeutic INR. At day 8, 67% of the HM patients had a therapeutic INR, compared with 42% of UC patients (P < 0.002). In addition, 26% of UC patients had a high INR, compared with only 4% of HM patients. Bleeding events were assessed 3 months after discharge and occurred in 15% of HM patients, compared with 36% of the UC group (P < 0.01). CONCLUSIONS: This programme improved the initiation of warfarin therapy and resulted in a significant decrease in haemorrhagic complications in the first 3 months of therapy.
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Jackson et al. (2004) conducted an RCT in Warfarin initiation (n=128). Home monitoring programme vs. Usual care was evaluated on Bleeding events at 3 months (p=< 0.01). A home monitoring programme for patients initiated on warfarin significantly reduced bleeding events at 3 months compared to usual care (15% vs 36%, P<0.01).
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