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- Title
Feasibility of Extended-interval Follow-up for Patients Receiving Warfarin.
- Authors
Carris, Nicholas W.; Spinelli, Alisa; Pierini, Danielle; Taylor, James R.; Anderson, Katherine Vogel; Sando, Karen; Powell, Jason; Rosenberg, Eric I.; Zumberg, Marc S.; Smith, Steven M.; Gums, John G.; Dietrich, Eric
- Abstract
Aims The 2012 American College of Chest Physician Evidence-Based Management of Anticoagulant Therapy guidelines suggest an international normalized ratio ( INR) testing interval of up to 12 weeks, rather than every 4 weeks, for patients with consistently stable INRs while taking vitamin K antagonists. We aimed to examine the feasibility of extended-interval follow-up in a real-world setting. Methods Patients receiving stable warfarin therapy for ≥12 weeks at baseline began extended-interval follow-up with visits occurring at 6 weeks, 14 weeks, and every 12 weeks thereafter to a maximum of 68 weeks or until they were no longer suitable for extended-interval follow-up. A single INR excursion >0.3 from goal was permitted if a reversible precipitating factor was identified and the INR was expected to return to goal without dose adjustment. The primary outcome was the proportion of patients completing all study follow-up visits. Results Of 48 patients enrolled, 47 had evaluable data. The most common indication for anticoagulation was atrial fibrillation/flutter (53.2%). At baseline, mean prior warfarin treatment duration was 6.7 ± 6 years and median number of weeks on a stable regimen was 24 weeks ( IQR, 19-37.5). Eleven patients (23%) completed all study follow-up visits, whereas 17 (36%) did not maintain a stable INR past the 14-week follow-up. Conclusion A large proportion of patients with previously stable (≥3 months) INRs were not able to maintain stable INRs during extended-interval follow-up. More research is needed to identify patient characteristics predictive of success with extended-interval follow-up prior to broad implementation.
- Subjects
WARFARIN; DRUG therapy; FOLLOW-up studies (Medicine); EVIDENCE-based medicine; ANTICOAGULANTS; AMERICAN College of Chest Physicians
- Publication
Cardiovascular Therapeutics, 2015, Vol 33, Issue 3, p98
- ISSN
1755-5914
- Publication type
Article
- DOI
10.1111/1755-5922.12115