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
Clinical Trial
. 2017 Sep;35(3):299-306.
doi: 10.1080/02813432.2017.1358857. Epub 2017 Aug 4.

Warfarin monitoring in nursing homes assessed by case histories. Do recommendations and electronic alerts affect judgements?

Reyes Serrano Teruel  1 , Geir Thue  1   2 , Svein Ivar Fylkesnes  1 , Sverre Sandberg  1   2   3 , Ann Helen Kristoffersen  1   3
Affiliations
Clinical Trial

Warfarin monitoring in nursing homes assessed by case histories. Do recommendations and electronic alerts affect judgements?

Reyes Serrano Teruel et al. Scand J Prim Health Care. 2017 Sep.

Abstract

Purpose: Older adults treated with warfarin are prone to complications, and high-quality monitoring is essential. The aim of this case history based study was to assess the quality of warfarin monitoring in a routine situation, and in a situation with an antibiotic-warfarin interaction, before and after receiving an electronic alert.

Materials and methods: In April 2014, a national web-based survey with two case histories was distributed among Norwegian nursing home physicians and general practitioners working part-time in nursing homes. Case A represented a patient on stable warfarin treatment, but with a substantial INR increase within the therapeutic interval. Case B represented a more challenging patient with trimethoprim sulfamethoxazole (TMS) treatment due to pyelonephritis. In both cases, the physicians were asked to state the next warfarin dose and the INR recall interval. In case B, the physicians could change their suggestions after receiving an electronic alert on the TMS-warfarin interaction.

Results: Three hundred and ninety eight physicians in 292 nursing homes responded. Suggested INR recall intervals and warfarin doses varied substantially in both cases. In case A, 61% gave acceptable answers according to published recommendations, while only 9% did so for case B. Regarding the TMS-warfarin interaction in case history B, the electronic alert increased the percentage of respondents correctly suggesting a dose reduction from 29% to 53%. Having an INR instrument in the nursing home was associated with shortened INR recall times.

Conclusions: Practical advice on handling of warfarin treatment and drug interactions is needed. Electronic alerts as presented in electronic medical records seem insufficient to change practice. Availability of INR instruments may be important regarding recall time.

Keywords: Warfarin; anticoagulants; drug interactions; electronic alerts; international normalized ratio; nursing homes; reminder systems.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Case histories and questionnaire.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Holbrook A, Schulman S, Witt DM, et al. . Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e152S–e184S. - PMC - PubMed
    1. Kristoffersen AH, Thue G, Ajzner E, et al. . Interpretation and management of INR results: a case history based survey in 13 countries. Thromb Res. 2012;130:309–315. - PubMed
    1. Kristoffersen AH, Thue G, Sandberg S.. Postanalytical external quality assessment of warfarin monitoring in primary healthcare. Clin Chem. 2006;52:1871–1878. - PubMed
    1. Rose AJ. Improving the management of warfarin may be easier than we think. Circulation. 2012;126:2277–2279. - PubMed
    1. Stewart A, Ganguli A, FitzGerald R, et al. . Variation in warfarin prescribing and dosing in the UK: a national survey of anticoagulation clinics. J Clin Pharm Ther. 2015;40:466–471. - PubMed

Publication types

MeSH terms

LinkOut - more resources