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Take the hassle out of taking warfarin

Less frequent testing or home monitoring may be options.

Despite the recent FDA approval of easier-to-use anticlotting drugs, millions of Americans continue to take warfarin (Coumadin, Jantoven, generic) to prevent dangerous blood clots. The most worrisome clots—which can cause a stroke or potentially fatal shutdown of lung function—arise from atrial fibrillation, deep-vein thrombosis, or the presence of an artificial heart valve.

Warfarin is a temperamental drug. Changing your diet, starting or stopping other medications, and your overall health can affect whether it keeps your blood just right, too prone to clotting, or so thin that you run the risk of internal bleeding. That’s why all people who take the drug should get periodic blood tests to confirm that their blood is in the right range. However, two recent studies suggest that monitoring warfarin could be less of a hassle.

Home warfarin monitor

Home warfarin monitor
photo courtesy of ITC

Every month or every three?

In a study looking at how often blood tests are needed, 250 people who’d been on a steady dose of warfarin for six months followed the standard regimen—a blood test once a month. The results for half of the participants were reported to their doctors after every test. For the other half, doctors got the results only every three months, unless the findings warranted medical intervention.

The amount of time the participants’ blood was in range was essentially the same in both groups. There were also no differences between the groups in the number of deaths or complications such as excessive bleeding (Annals of Internal Medicine, Nov. 15, 2011).

Before you ask your doctor if you can be monitored every three months, remember that those in the study’s three-month group were still seen monthly by a health care professional. It’s possible that people in this group wouldn’t have been so reliably in range if they didn’t have such frequent contact with clinicians.

Home monitoring is feasible

The second study focused on home monitoring. Researchers analyzed data from 11 different trials that included about 6,400 people. They found that the number of events caused by traveling blood clots (thromboemboli) in people who monitored their blood at home was about half that of those who went to a clinic for monitoring. There were, however, no significant differences between the groups in the number of deaths or excessive bleeding episodes (The Lancet, published online Dec. 1, 2011).

When considering these results, remember that home monitoring is feasible only if you have the manual and visual dexterity to prick your finger and handle the push-button measuring equipment. Also, Medicare covers home monitoring equipment and supplies, as do most but not all other insurers.

Ultimately, you and your doctor should decide on an optimal warfarin-monitoring routine. Consider alterations in venue or frequency only if you have a six-month track record of being in range with few or no dosage adjustments. And remember that less frequent contact with the clinic or monitoring from home reduces the amount of potentially helpful advice you’d receive from health care providers.

Posted by: Dr.Health

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