How can pharmacists improve the management of warfarin therapy?

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 coordinated.