New Strategy for Early Warfarin Control Key for Patients
By: Alere Staff
Publication Date: Fri, 03/01/2013
Warfarin for patients undergoing mechanical heart valve replacement is the standard of care to prevent thrombosis. Doctors use injectable heparin or low molecular weight heparin and give warfarin to prevent a dangerous blood clot from forming. Their goal is to get patients out of the hospital as quickly as possible to keep your costs, and their costs down.
Warfarin can be a tricky drug to begin and get just right for each patient. Most major problems occur in the first month of warfarin use.1 In fact, warfarin (brand name Coumadin® medication) and new drug Pradaxa® were the most common drugs reported for serious side effects in 2011.2 The Center for Medicare and Medicaid Services (CMS) implemented a Hospital Readmission Reduction Program in 2010 to address the high incidence of CMS patient readmission.
“Within 30 days of discharge, 17.6 percent of Medicare beneficiaries nationwide are re-hospitalized, and the Medicare Payment Advisory Commission (MedPAC) estimated that up to 76 percent of these readmissions may be preventable. Of Medicare beneficiaries who are readmitted within 30 days, 64% receive no post-acute care between discharge and readmission, according to a 2007 MedPAC report.”3
Starting warfarin means you need to return to your hospital or clinic for frequent blood tests, often 2-3 times per week for the first few weeks. More frequent blood draws are common until the dose for you is determined. Four to six weeks to find a patient’s proper dose is common. Patients who have received a mechanical heart valve have shown a short-term increased response to lower doses of warfarin following surgery.4
Good news may be on the way. While Medicare covers the cost of self-testing – it does not include the first 90 days, the three months when many patients have poor control of warfarin and side effects occur.
A 2012 study found that patient self-testing that began while patients were still in the hospital (following surgery) did better than patients who did not self test.5 Authors found patients spent more time in their therapeutic range than patients required to visit their clinic or return to the hospital for INR testing. Self-testing presents a less burdensome method of generating frequent INR tests and reduces travel to and from clinics and waiting time.5
Starting self-testing is practical and can improve quality of life. Better warfarin control will reduce patients from returning to the hospital with bleeding or blood clot issues. An effort to further expand reimbursement for self-testing is underway.
If you are interested in testing your INR in your home, go to the Getting Started page for more information or call Alere at 1.800.504.4032.
- White, RH. Major bleeding after hospitalization for deep vein thrombosis. American Journal of Medicine. November, 1999. 107(5): 414-24
- Institute for Safe Medication Practices, QuarterWatch. Monitoring FDA MedWatch Reports. Anticoagulants the Leading Reported Drug Risk in 2011 May 31, 2012. New Data from 2011 Quarters 3 – 4
- Pennsylvania Quality Improvement Organization.‘Insights to Quality Newsletter’, Improving Care Transitions. July 2012 Website: http://www.qipa.org/Quality-Improvement/Integrating-Care.aspx
- Rahman, M. Increased sensitivity to warfarin after heart valve replacement. Annals of Pharmacotherapy. 2008. 40: 397-401.
- Thompson, J. Anticoagulation early after mechanical heart valve replacement: Improved management with patient self-testing. Journal of Thoracic and Cardiovascular Surgery. 2012. 1-6.