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Anticoagulant monitoring
Last revised in May 2006
Dr JP Ng Ping Cheung
Dr KK Hampton
The great variation in response to warfarin between and within patients dictates the need to monitor and maintain the desired therapeutic international normalized ratio (INR) in order to ensure the effectiveness and safety of warfarin. It is also important to realise that careful selection and continuing risk assessment of patients with regard to hazards and benefits of anticoagulation is as important as INR monitoring.
Patient self-monitoring of anticoagulant therapy may be restrictive because of (i) exclusion rates (> 60%, range 31–88%) based on trials evaluated [Heneghan et al, 2006] and (ii) the higher cost associated with self-monitoring, with one study [Fitzmaurice et al, 2002] quoting £90 as the cost for primary care monitoring compared to £425 per patient/year for the self-monitoring group. The pressure on primary care to continue providing anticoagulant monitoring [Fitzmaurice et al, 2000] is therefore likely to continue.
BetterTesting
You can access tests of the week previously featured on the CKS website, and browse the full resource of approximately 100 questions from the Best Practice in Pathology project, by visiting the new Better Testing website at www.bettertesting.org.uk.
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