Clinical Outcomes of Telemonitoring for Patients on Warfarin after Discharge from Hospital.

Natthaporn Sudas Na Ayutthaya,Teerapon Dhippayom,Itsarawan Sakunrak

doi:10.1155/2018/7503421

Abstract

Objective To evaluate the impact of telephone follow-up service on clinical outcomes in patients on warfarin when discharged from hospital. Methods This randomized controlled trial was conducted at a general hospital in Thailand. Patients aged ≥20 years who were prescribed warfarin when discharged were eligible to participate in this study. They were randomly allocated, using a computer generated random number, to receive either telephone follow-up intervention or usual care. Participants in the intervention group received telephone follow-up by hospital pharmacists for three months. During each telephone call, pharmacists performed medicine use reviews and addressed any problems identified. Key Findings A total of 50 patients participated in this study. The proportion of international normalized ratio (INR) values in the target range for the telephone follow-up group (36/79, 45.6%) was higher than that in the usual care group (19/79, 24.1%), p=0.005. The mean time in the therapeutic range (TTR) in the telephone follow-up group was also higher than that in the usual care group (49.8±34.3 versus 28.0±27.5, p=0.017). All patients in the usual care group experienced one or more out-of-range INR values (25/25, 100%) compared to 21 out of 25 (84%) in the telephone follow-up group, p=0.037. There was no difference between the two groups in the incidence of complications or adverse events associated with warfarin. Conclusions The telephone follow-up service in recently discharged patients helps them achieve and maintain their INR target. This anticoagulant supportive service should be promoted to patients receiving warfarin therapy after discharge. This trial is registered with TCTR20180614006 (Thai Clinical Trials Registry).

Highlights

Warfarin is a well-established oral anticoagulant used for the prevention and treatment of thromboembolism and thromboembolic complications in patients with atrial fibrillation, heart valve replacement, or myocardial infraction [1]
The majority of participants in the telephone followup group were female (18/25, 72%), which was different in the usual care group (12/25, 48%)
Hospitalized patients who were discharged on warfarin and received the telephone follow-up service had a higher rate of international normalized ratio (INR) in target range and a higher therapeutic range (TTR) percentage than those who received usual care

Summary

Introduction

Warfarin is a well-established oral anticoagulant used for the prevention and treatment of thromboembolism and thromboembolic complications in patients with atrial fibrillation, heart valve replacement, or myocardial infraction [1]. Due to its narrow therapeutic index and dosage variability among patients, individuals receiving warfarin therapy require dose adjustment based on the international normalized ratio (INR) to reduce the risk of adverse reaction such as thrombotic and bleeding events that could lead to hospitalization or life-threatening conditions [2]. Several studies have demonstrated that pharmacistmanaged anticoagulation clinics improve time in therapeutic range, lower the incidence of adverse events, and reduce the need for frequent office/anticoagulant clinic visits [3]. The advantages of telephone-based management of warfarin are that it provides time and cost savings, increases access to care, provides convenience, and reduces the risk of anticoagulation therapy related complications. Anticoagulant management via telephone calls might not be feasible everywhere as it requires INR measurements, and healthcare structures in some areas may not support the implementation of this service due to limited access to INR measurement facilities outside hospital settings. A previous study revealed that continuous warfarin followup counseling through phone calls and home visits helped improve INR control in patients discharged on warfarin [8]

Results

Discussion

Conclusion