Warfarin management in haemodialysis--are we meeting British Haematology Society standards?
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.


CONCLUSIONS
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.
Department of Pharmacy, Manchester Royal Infirmary, Manchester, UK. kathrine.parker@cmft.nhs.uk
Kathrine
K
Parker
Marc
M
Vincent
Sandip
S
Mitra
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006405:Hematology; D006406:Hematoma; D006801:Humans; D019934:International Normalized Ratio; D006435:Renal Dialysis / Q000379:methods*; D012955:Societies, Medical; D016896:Treatment Outcome; D006113:United Kingdom; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin