Rocky C
11-04-10, 04:37 PM
Blood-Thinning Pills Work with Either Home or Clinic Testing
VA Study Finds Similar Results
WASHINGTON (Nov. 4, 2010)-- Patients taking warfarin, a widely used
blood-thinning pill that requires careful dose monitoring, have similar
outcomes whether they come to a clinic or use a self-testing device at
home, according to a recent Department of Veterans Affairs (VA) study.
The findings, published in the Oct. 21 issue of the New England Journal
of Medicine, are good news for heart patients who live far from clinics
or are homebound.
"This study helps answer an important question for cardiologists,
primary care physicians and other health providers, and will lead to
improved care for their patients," says VA Chief Research and
Development Officer Joel Kupersmith, MD, himself a cardiologist. "The
results are significant for a great number of Veterans currently
receiving care through VA."
Traditionally, doctors, pharmacists and nurses monitor patients who are
taking warfarin, sold as Coumadin, over several clinic visits. They test
how fast the blood clots and adjust the dose accordingly: Too low a dose
will not prevent dangerous blood clots and blood flow to the heart,
brain or other areas of the body could be inadvertently blocked. Too
high a dose could lead to dangerous internal bleeding.
Patients have the option of tracking their own blood response at home,
using blood analyzers known as international normalized ratio (INR)
monitors. Patients do a finger stick, apply a small amount of blood to a
test strip and feed the strip into the device. The procedure resembles
the one used by people with diabetes to check their blood sugar.
Patients can then call in the results to their provider and get advice
on dose adjustments without coming to the clinic. In some cases, they
can even set the proper dose of warfarin on their own.
The authors of the VA study expected home monitoring to work better than
clinic monitoring, partly because self-testing can be done at home more
frequently-weekly, compared with the typical monthly schedule of the
best clinic-based monitoring. As a result, off-target INR values can be
adjusted more regularly and more quickly.
However, the VA study found little difference between weekly
self-testing and monthly testing by clinic-based care teams in the
measured outcomes, which are strokes, major bleeding incidents and
death.
The study did find, though, that self-testing at home may offer
advantages in other areas: It moderately boosted patients' satisfaction
with the medication and slightly increased the length of time they were
in the appropriate dose range.
Study co-leaders were Dr. David Matchar, M.D., an internist with the
Durham, N.C., VA Medical Center, Duke University School of Medicine and
Duke-NUS Graduate Medical School, and Dr. Alan Jacobson, M.D., a
cardiologist and researcher with VA and Loma Linda, Calif., University
School of Medicine. They said the main message of the study is that
patients who are systematically monitored-no matter by what means-are
likely to have good outcomes.
The study was sponsored by VA's Cooperative Studies Program, part of the
VA Office of Research and Development.
VA Study Finds Similar Results
WASHINGTON (Nov. 4, 2010)-- Patients taking warfarin, a widely used
blood-thinning pill that requires careful dose monitoring, have similar
outcomes whether they come to a clinic or use a self-testing device at
home, according to a recent Department of Veterans Affairs (VA) study.
The findings, published in the Oct. 21 issue of the New England Journal
of Medicine, are good news for heart patients who live far from clinics
or are homebound.
"This study helps answer an important question for cardiologists,
primary care physicians and other health providers, and will lead to
improved care for their patients," says VA Chief Research and
Development Officer Joel Kupersmith, MD, himself a cardiologist. "The
results are significant for a great number of Veterans currently
receiving care through VA."
Traditionally, doctors, pharmacists and nurses monitor patients who are
taking warfarin, sold as Coumadin, over several clinic visits. They test
how fast the blood clots and adjust the dose accordingly: Too low a dose
will not prevent dangerous blood clots and blood flow to the heart,
brain or other areas of the body could be inadvertently blocked. Too
high a dose could lead to dangerous internal bleeding.
Patients have the option of tracking their own blood response at home,
using blood analyzers known as international normalized ratio (INR)
monitors. Patients do a finger stick, apply a small amount of blood to a
test strip and feed the strip into the device. The procedure resembles
the one used by people with diabetes to check their blood sugar.
Patients can then call in the results to their provider and get advice
on dose adjustments without coming to the clinic. In some cases, they
can even set the proper dose of warfarin on their own.
The authors of the VA study expected home monitoring to work better than
clinic monitoring, partly because self-testing can be done at home more
frequently-weekly, compared with the typical monthly schedule of the
best clinic-based monitoring. As a result, off-target INR values can be
adjusted more regularly and more quickly.
However, the VA study found little difference between weekly
self-testing and monthly testing by clinic-based care teams in the
measured outcomes, which are strokes, major bleeding incidents and
death.
The study did find, though, that self-testing at home may offer
advantages in other areas: It moderately boosted patients' satisfaction
with the medication and slightly increased the length of time they were
in the appropriate dose range.
Study co-leaders were Dr. David Matchar, M.D., an internist with the
Durham, N.C., VA Medical Center, Duke University School of Medicine and
Duke-NUS Graduate Medical School, and Dr. Alan Jacobson, M.D., a
cardiologist and researcher with VA and Loma Linda, Calif., University
School of Medicine. They said the main message of the study is that
patients who are systematically monitored-no matter by what means-are
likely to have good outcomes.
The study was sponsored by VA's Cooperative Studies Program, part of the
VA Office of Research and Development.