Home Monitoring For People Taking Coumadin
Coumadin (warfarin) is a blood thinner commonly used to prevent blood clots in patients with atrial fibrillation, valvular heart disease, and other conditions in which there is a high risk of clotting problems. The major problem with taking Coumadin is that the dose needs to be adjusted periodically to achieve the right amount of "blood thinning." Too little Coumadin and clots can develop; too much, and bleeding complications can occur.
A blood test called the INR test tells how thin the blood is. Patients on Coumadin usually should have INR tests monthly, and in many cases more often than that, to adequately regulate their dosage. The process of dosage adjustment is frequently quite cumbersome for both patients and their doctors, and all too often gaps in communication lead to poor control of Coumadin dosages.
In The Home INR Study, roughly 3000 patients were randomized to home monitoring of INR levels or to a well-organized monthly Coumadin clinic. After an average of 54 months of follow-up, there was no significant difference in the incidence of either clotting events, or bleeding events, between the two groups.
This study shows that home monitoring of INR levels can be as safe and effective as doing the INR monitoring in a well-run outpatient clinic. Since the majority of patients on Coumadin seem have their INRs regulated in systems that are more haphazard than well-run, this study strongly suggests that more patients be taught to self-monitor their INR values.
Patients on Coumadin therapy who find monitoring their INR values on an outpatient basis to be cumbersome or poorly coordinated should talk to their doctors about being set up with a home monitoring system. Medicare now covers such home monitoring for many patients taking Coumadin.
Comments
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