Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jul 12;15(7):e138.
doi: 10.2196/jmir.2255.

Supervised patient self-testing of warfarin therapy using an online system

Luke Ryan Elliot Bereznicki  1 , Shane Leigh Jackson, Gregory Mark Peterson
Affiliations

Supervised patient self-testing of warfarin therapy using an online system

Luke Ryan Elliot Bereznicki et al. J Med Internet Res. .

Abstract

Background: Point-of-care international normalized ratio (INR) monitoring devices simplify warfarin management by allowing selected patients to monitor their own therapy in their homes. Patient self-testing (PST) has been shown to improve the clinical outcomes of warfarin therapy compared to usual care.

Objective: To compare management of warfarin therapy using PST combined with online supervision by physicians via a custom system with usual warfarin management, which involved laboratory testing and physician dosing.

Methods: Interested patients were recruited via community pharmacies to participate in a warfarin PST training program. Participants were required to have a long-term indication for warfarin, have been taking warfarin for at least 6 months, and have Internet access in their home. The training involved two sessions covering theoretical aspects of warfarin therapy, use of the CoaguChek XS, and the study website. Following training, patients monitored their INR once weekly for up to 3 months. Patients and physicians utilized a secure website to communicate INR values, dosage recommendations, and clinical incidents. Physicians provided a 6-12 month history of INR results for comparison with study results. The percentage of time spent within the therapeutic INR range (TTR) was the primary outcome, with participants acting as their own historical controls. The percentage of INR tests in range and participant satisfaction were secondary outcomes.

Results: Sixteen patients completed training requirements. The mean age of participants was 69.8 (SD 10.1) years. TTR improved significantly from 66.4% to 78.4% during PST (P=.01), and the number of tests within the target range also improved significantly (from 66.0% at prior to the study to 75.9% during PST; P=.04). Patients and physicians expressed a high degree of satisfaction with the monitoring strategy and online system.

Conclusions: PST supported by an online system for supervision was associated with improved INR control compared to usual care in a small group of elderly patients. Further research is warranted to investigate the clinical outcomes and cost-effectiveness of online systems to support patients monitoring medications and chronic conditions in the home.

Keywords: Internet; communication; international normalized ratio; management; self-care; warfarin.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have received funding from Roche Diagnostics Australia, who also provided CoaguChek XS devices and consumables for this project. The study sponsors and funder did not have any involvement in the study design, the collection, analysis or interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication.

Figures

Figure 1
Figure 1
Patient recruitment.
Figure 2
Figure 2
Individual percentage of time in therapeutic range (TTR) during patient self-testing (PST) and usual care (UC) (the dotted line shows the mean TTR for each management approach).
Figure 3
Figure 3
Percentage of time in therapeutic range for patient self-testing vs usual care.
See this image and copyright information in PMC

References

    1. Beyth RJ, Landefeld CS. Learning the respective roles of warfarin and dabigatran to prevent stroke in patients with nonvalvular atrial fibrillation. Ann Intern Med. 2011 Nov 15;155(10):714–5, W218. doi: 10.1059/0003-4819-155-10-201111150-00012. - DOI - PubMed
    1. Legrand M, Mateo J, Aribaud A, Ginisty S, Eftekhari P, Huy PT, Drouet L, Payen D. The use of dabigatran in elderly patients. Arch Intern Med. 2011 Jul 25;171(14):1285–6. doi: 10.1001/archinternmed.2011.314. - DOI - PubMed
    1. Ansell J. New oral anticoagulants should not be used as first-line agents to prevent thromboembolism in patients with atrial fibrillation. Circulation. 2012 Jan 3;125(1):165–70; discussion 170. doi: 10.1161/CIRCULATIONAHA.111.031153. http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=22215891 - DOI - PubMed
    1. Epstein RS, Moyer TP, Aubert RE, O Kane DJ, Xia F, Verbrugge RR, Gage BF, Teagarden JR. Warfarin genotyping reduces hospitalization rates results from the MM-WES (Medco-Mayo Warfarin Effectiveness study) J Am Coll Cardiol. 2010 Jun 22;55(25):2804–12. doi: 10.1016/j.jacc.2010.03.009. - DOI - PubMed
    1. Tang EO, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. Relationship between patients' warfarin knowledge and anticoagulation control. Ann Pharmacother. 2003 Jan;37(1):34–9. - PubMed

Publication types