Improving the outcomes of anticoagulation: an evaluation of home follow-up of warfarin initiation.
OBJECTIVE
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.


METHODS
Open-label randomized controlled trial.


METHODS
Home-based follow-up of patients discharged from acute care hospital in southern Tasmania, Australia.


METHODS
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).


METHODS
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.
Jackson
S L
SL
School of Pharmacy, University of Tasmania, Tasmania, Australia.
Peterson
G M
GM
Vial
J H
JH
Jupe
D M L
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005194:Family Practice; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006792:House Calls; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010595:Pharmacists; D019095:Point-of-Care Systems; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin