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Self-monitoring INR and self-managing warfarin to reduce thromboembolic events

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Posted Jan 20, 2012 at 07:30 AM, EDT by Samuel Goldhaber

A recent study published in the Lancet reports a 50% reduction in thromboembolic events among patients who self-monitor their INR and self-manage their warfarin dosing. Why aren't these practices more common?

See also:

Anticoagulation self-monitoring halves thromboembolic risk  

Heneghan C, Ward A, Perera R, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data.  Lancet 2011; DOI:10.1016/S0140-6736(11)61294-4. Abstract.

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Just to inform you, finger stick machines are NOT accurate in Antiphospholipid Antibody Syndrome (APS) patients. Supporting information is here: http://www.apsfa.org/links/links22.htm .
Posted by APSFA, Jan 22, 2012 at 06:12 PM, EDT
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I am a former perfusionist retired with three open-heart surgeries, Atril Fib, prosthetic Aortic valve.  I cannot do without my Philips I.N.R. machine.  My Protime is very labile and I need to make adjustments along the way. I cannot wait a one month until the next I.N.R. I have found that it is right on with the I.N.R. clinic and I take it twice a week.  My I.N.R. can go as low as 2.0 when I need to be 2.5 to 3.5.  It's simple, fast and I don't have to live in fear that I'm out of range.
Posted by Carl Bell, Jan 28, 2012 at 12:44 AM, EDT
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I have Afib for over 20 years and about 4 years ago, while vacationing on Long Island, NY my INR went of the chart and I hit my back while sailing! After 3 painful nights trying to sleep I went to a doctor and he said have seen your back where one side had turned black from bleeding. He immediately gave me a shot of Vitamin K to conteract the cuamadin and I noticed he was using a Roche device to check my INR.

When I got home I contacted Roche's website and learned that patients could get their CoaguChek device through Medicare and ordered one immediately! They sent a retired nurse to my house with a new device and test strips to show me how to use it! I take my INR every 3 weeks and report the test results on their website and they fax my doctor. If it various from the prescribed 2 to 3, I adjust the dosage slightly myself and retest the following week to check the results.

I would highly recommend Afib patients taking there own INR as I have for over 3 years with great results and no problems! 


Posted by George Jewett, Feb 03, 2012 at 12:15 PM, EDT
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If dabigatran only reaches therapeutic levels 62 percent of the time (2011 study), would it not be good to measure INR every once in awhile, e.g., before a first DC cardioversion?
Posted by Gorgonzola, Feb 03, 2012 at 12:45 PM, EDT
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This comment is a reply to Gorgonzola (Feb 27, 2012 at 10:37 PM, EDT)
Gorgonzola: I'm confused by your comments; in RE-LY it was dose-adjusted warfarin that had therapeutic challenges...dabi was not measured for INR levels.
Posted by FadiBejjani, Feb 27, 2012 at 10:37 PM, EDT
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