Top 10 Variables: Compliance

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Friday, June 1, 2007

PTINR.com Staff

Medications only work when they’re taken as directed. See how compliance plays a key role in INR fluctuations.

Medications only work when they’re taken properly. The efficacy and safety of a medicine is directly related to how well a patient sticks to their dosing regimen. Warfarin is normally taken once a day in dosages ranging from as little as 1 milligram per day for highly sensitive patients to 25 milligrams or more for younger, larger, or less warfarin (Coumadin ®)-sensitive patients. The “right” dose is highly individualized and needs to be determined by a qualified physician.

The INR is the term used to describe the blood test for patients on warfarin. A very high INR number suggests too much warfarin has been taken. A number below 2.0 suggests too little warfarin or the warfarin taken has been interacted with another medication. As a general rule, most patients are controlled within an INR range between 2.0 and 3.0. Patients with mechanical heart valves are typically kept between 2.5 and 3.5.. Each patient is evaluated individually and given an INR target that meets their clinical need. The target range gives a range for people to aim for.

When patients forget to take their warfarin or take it inconsistently they should expect their INR test result number to go down. This increases the risk for dangerous blood clots. An overdose by accident or intent will result in a very high INR dramatically increasing the risk of bleeding from any tissue or organ.

An unexpected INR test result should result in a review of the patient’s compliance a week or two leading up to the test result. Study’s showed missing 10% of doses resulted in a 14% in under-anticoagulation while a 20% missed dosing resulted in a 2-fold increase in odds of under anticoagulation.

Pill boxes are excellent tools for warfarin patients. Most patients taking warfarin are taking many other medications including vitamins. It is difficult to keep all pills, tablets, gel-caps and caplets organized and perfect compliance without a system to ensure good compliance.

To encourage and recognize good compliance, QAS, Inc., host of this website, supports a compliance recognition program called the IN-Range® Achievement program. The program is for patients who test at home and offers laminated performance cards for various levels of compliance success. Questions about the QAS IN-Range Achievement program can be sent to Gary Liska, program coordinator (gliskaqasmail.com).