Home prothrombin time monitoring after the initiation of warfarin therapy: a randomized, prospective study

Article Abstract:

Many thromboembolic disorders, which are characterized by blood clots that can block the blood vessels, are treated with oral anticoagulation therapy. Anticoagulant drugs thin the blood, and consequently their side effects include episodes of bleeding that can be serious. Close monitoring and appropriate dosage adjustment are important for patients on these drugs. Prothrombin time refers to a test that measures the time it takes for clotting to occur; it is used to evaluate effective administration of anticoagulant drugs. A portable device used to monitor levels of prothrombin has been developed; the approach is similar to home blood glucose monitoring for diabetics. The efficacy, accuracy and feasibility of this method was examined in 46 patients who had just begun treatment with warfarin, an anticoagulant drug. Patients were also selected because they appeared capable of using the monitoring device at home, and because they needed to monitor prothrombin time closely since they had shown inconsistent response to the drug in the hospital. During the eight-week study, patients monitored themselves with this device at home, and 23 patients who were used as a control group were monitored in a clinic. No major thromboembolic or hemorrhagic complications occurred in either group. When both groups were compared with the target range (optimal prothrombin times), the home-based group was within this range 93 percent of the time and the clinic group was within this range only 75 percent of the time. It was concluded that for patients being treated with oral anticoagulation drugs, the home monitoring method provides care that is superior to clinic monitoring. The prothrombin time device was also accurate, easy to use, and inexpensive. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Measurement, Anticoagulants (Medicine), Anticoagulants, Prothrombin time, Medical test kits

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The risk for and severity of bleeding complications in elderly patients treated with warfarin

Article Abstract:

Elderly patients taking warfarin do not appear to have a higher overall risk for bleeding complications than middle-aged patients. Researchers compared the frequency of bleeding episodes in 2,376 patients taking warfarin according to their age. The overall frequency of bleeding episodes as well as those requiring minimal or no medical intervention did not increase with age. However, the risk for life-threatening bleeding complications or death from these complications was more than four times higher in patients older than 80 years of age compared to those younger than 50 years of age. The most common bleeding location leading to life-threatening complications or death was in the stomach or intestines, which occurred in 64% of the patients. Patients with a change in their prothrombin time ratio were at greatest risk for bleeding complications. Older patients did not require as much warfarin to maintain an acceptable prothrombin ratio.

Complications and side effects, Risk factors, Bleeding

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Temporary discontinuation of warfarin therapy: changes in the international normalized ratio

Article Abstract:

It appears that patients taking the anticoagulant warfarin should discontinue it 96 to 115 hours before surgery to minimize the risk of excessive blood loss. Coagulation times were monitored among 22 patients taking warfarin for whom temporary discontinuation was deemed safe. Almost all patients had an acceptable INR by 115 hours or 5 days after discontinuing therapy if an international normalized ratio (INR) of 1.5 is considered safe to perform surgery. Older patients took longer than younger patients to achieve a safe INR level probably because they took longer to eliminate warfarin from their systems.

Dosage and administration

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