Think you know all there is to know about managing warfarin? Think again.

You know that warfarin has been used for more than 60 years to prevent blood clots. And you know that it works; its effectiveness is well-established. You’re probably also aware that warfarin therapy can be challenging — with diet restrictions, drug interactions, and the need for regular INR monitoring.

So, what’s the best way to manage warfarin therapy: a family doctor’s office, a specialized anticoagulation clinic, or patient self-testing and self-management? If you think you know the answer, you might be in for a surprise.

Based on the best available evidence, it turns out that there isn’t a lot of difference in patient outcomes between different models of care. See the CADTH recommendations for more information.

What matters is having a structured care plan in place.

How often have you “eyeballed” a warfarin dose because you didn’t have a validated nomogram at hand? Have you ever had a patient go for months without an INR test? Has a patient missed vital education because every member of the care team thought someone else would do it? Patients can slip through cracks in the health system, but a structured care plan can help catch them.

Things to consider when developing a structured plan

  • Patient follow-up. When is the next INR due? When is the next office visit?
  • INR monitoring. Who will receive and triage the results? Who will contact the patient? Is this answer different for in-range versus out-of-range INRs?
  • Dose adjustment. If a dose adjustment is needed, which validated tool will be used? Is it electronic or paper-based, and where do we keep it?
  • Patient education. Who is responsible for patient education? How will we ensure ongoing patient education and adherence, as well as caregiver engagement?
  • Monitoring. Who is responsible to monitor for side effects and complications?

Bottom line

  • Optimal management of warfarin is possible in all practice settings. It’s not that difficult, but it needs a bit of attention and a structured care plan.