How can pharmacists improve the management of warfarin therapy?
Bereznicki, LRE, How can pharmacists improve the management of warfarin therapy?, In: APSA 2009 : Out of the wilderness : Proceedings of the Australasian Pharmaceutical Science Association annual conference 2009 , 9 - 11 December 2009, Wrest Point Convention Centre, Hobart Tasmania, pp. 62. ISBN 978-0-646-52257-9 (2009) [Conference Extract]
The therapeutic benefits of warfarin are highly dependent on mqaintaining the international normalised ratio
(INR) within the therapeutic range. Poor compliance, variable dietary intake, drug interactions, inadequate
knowledge, and miscommunication between the patient and physician have all been cited in the literature as
potential causes for fluctuations in the INR. Points of care (POC) INR monitors simplify warfarin management
by allowing people to monitor and manage their own therapy in their homes. For consumers with a long-term
indication for warfarin, PSM of warfarin therapy has emerged as the gold standard of care for those willing
and able to perform it. The benefits of PSM have now been well established in several countries and include
a greater proportion of time spent in the INR therapeutic range, a reduction in the number of haemorrhagic
and thromboembolic events, reduced mortality, improved warfarin knowledge and improved quality of life.
Portable INR monitors are readily available and are becoming less expensive and easier to use. It is difficult
to close evidence to practice gaps in healthcare, and many barriers must be indentified and overcome.
Pharmacists are well placed to promote and facilitate PSM for interested consumers, and provide support for
those who are already self-monitoring. The potential for pharmacy involvement in training consumers who
take warfarin and are willing and able to self-monitor their treatment is immense and pharmacists can
embrace this role. In addition, there is scope to improve the knowledge and hence anticoagulation control, of
all patients taking warfarin in Australia using a structured education program delivered by pharmacists. As
different healthcare professionals become more involved in the monitoring of chronic medications and
conditions, innovative communication strategies must be developed in parallel to ensure that care is