Altering Warfarin Management Seen to Improve Care, Decrease Costs

Changing warfarin management may prevent patients from receiving too much or too little of the drug.

Changing the way physicians manage warfarin drug therapy has the potential to save both money and patient lives, according to a recent study published by the Annals of Pharmacotherapy.

Warfarin a commonly-used anticoagulant that treats and prevents the formation of blood clots that lead to stroke and other health events. Management of this drug is typically measured by how long a patient remains in a certain therapeutic range where they are not at risk of blood clots or excessive bleeding.

If the warfarin regimen falls short, patients may be at an increased risk of experiencing a stroke or cardiovascular event, such as a heart attack. On the other hand, if the patient is taking too much of the drug, they may be at risk of experiencing a bleeding event, which may lead to hospitalization or death.

Other studies have shown that hospitals and physicians vary how they manage warfarin treatment, according to the study. This may lead to inconsistent treatment, with some patients receiving an unnecessarily high or low amount of the drug. To evaluate this knowledge gap, investigators created multiple measures that are meant to guide physicians, and improve the management of warfarin.

The investigators examined patients taking warfarin in 8 different Veterans Affairs (VA) medical centers located in the New England region, along with patients taking the drug in other parts of the country. The new guidelines were implemented to determine if changing warfarin management was beneficial.

"Patients who used these measures did better clinically than those in the control group," said corresponding author Adam Rose, MD.

While previous studies have indicated that improving warfarin management at a single location improves outcomes, this is the first study to do this across a health network, the researchers said.

“This study serves as a model for how other sites and health networks could feasibly approach improving the management of warfarin in their systems,” Dr Rose said. “If all anticoagulation clinics in the VA were to achieve this level of improvement, it would prevent 48 strokes and 68 major bleeding events each year, with a savings to the VA system of more than $4 million annually.”

The investigators believe that if other health systems implemented these guidelines, they could improve patient outcomes and save a significant amount of money by mitigating costly adverse events.

"Insufficient attention has been given in the past to how we can improve the management of warfarin; this study demonstrates that a relatively simple approach can have a large impact,” Dr Rose concluded.