Anticoagulation treatments
Warfarin may have a significant number of adverse effects on the patient but still remains one of the most effective anticoagulation treatments.
...for a large number of patients.
Warfarin has a narrow therapeutic range and remains a difficult drug to manage, especially in the post-discharge period. Shorter periods of hospitalisation, coupled with increasing warfarin usage, are placing additional stress on the community-based services caring for anticoagulated patients.
Patients, especially those from rural and remote regions, are at increased risk of these events due to problems with access to health care providers and services. Because of the need to frequently monitor the patient’s INR, there is some reluctance to prescribe warfarin to patients in rural areas. The availability of portable international normalised ratio (INR) monitors such as the Coaguchek XS is particularly attractive at the general practice, including rural or remote settings, because of the lack of access to pathology services.
The clinical benefits of warfarin are highly dependent on maintaining the INR within the therapeutic range. Patient self-monitoring (PSM) is considered the gold standard for warfarin management, which can result in over 70% of time spent in the therapeutic range. Self-monitoring involves patients measuring their INR with a portable device and referring to a healthcare practitioner for guidance on dosage changes.
The Pharmaceutical Society of Australia has information for people on warfarin at http://www.psa.org.au/site.php?id=3809. or call 02 6283 4777