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Improving the outcomes of anticoagulation: An evaluation of home follow-up of warfarin initiation


Jackson, SL and Peterson, GM and Vial, JH and Jupe, DML, Improving the outcomes of anticoagulation: An evaluation of home follow-up of warfarin initiation, Journal of Internal Medicine, 256, (2) pp. 137-144. ISSN 0954-6820 (2004) [Refereed Article]

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DOI: doi:10.1111/j.1365-2796.2004.01352.x


Objectives. 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. Design. Open-label randomized controlled trial. Setting. Home-based follow-up of patients discharged from acute care hospital in southern Tasmania, Australia. Subjects. 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). Interventions. 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.

Item Details

Item Type:Refereed Article
Keywords:anticoagulation;education;haemorrhage;INR monitoring;warfarin
Research Division:Health Sciences
Research Group:Health services and systems
Research Field:Health and community services
Objective Division:Health
Objective Group:Other health
Objective Field:Other health not elsewhere classified
UTAS Author:Jackson, SL (Dr Shane Jackson)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
UTAS Author:Vial, JH (Associate Professor Janet Vial)
UTAS Author:Jupe, DML (Dr David Jupe)
ID Code:30003
Year Published:2004
Web of Science® Times Cited:46
Deposited By:Pharmacy
Deposited On:2004-08-01
Last Modified:2011-05-24

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