Patients taking warfarin should have the option of a self-monitoring device to help them control their dose and reduce NHS costs, according to new recommendations.
Experts from the National Institute for Health and Care Excellence (NICE) said offering self-monitoring would help to get more patients on anticoagulation, improve patients’ INR control and lead to fewer clinic visits and better outcomes.
Adults with atrial fibrillation or heart valve disease who are on long-term anticoagulation therapy and who are at higher risk of developing blood clots, can use self-monitoring coagulometers such as the Coaguchek XS system (Roche Diagnostics) and the InRatio2 PT/INR Monitor, according to NICE guidance.
The devices monitor how quickly blood clots using a measure known as the international normalised ratio (INR). The INR enables the dose of anticoagulant to be adjusted if required. This in turn can help prevent major bleeding, heart attack or stroke that can result from an over- or under-dose of anticoagulant.
Self-monitoring can involve either self-testing (where the user performs the INR test themselves and then contacts their health professional for advice on any change to the dosage of anticoagulant that may be required) or self-managing (where the user performs the INR test themselves and then adjusts the dosage of their anticoagulant medication by following an agreed care protocol).
“The evidence shows that greater use of self-monitoring offers clinical and patient benefit and, over time, is likely to result in reductions in heart attacks and strokes caused by blood clots,” said Professor Carole Longson, NICE Health Technology Evaluation Centre Director.
“People on long-term anticoagulation need to monitor their blood regularly to make sure they are taking the right dose of their drug. Apart from the anxiety associated with waiting for the results from an anticoagulation test and in continuing normal daily activities without knowing the risk of a bleed or clot, the time and cost of attending an anticoagulation clinic can be a significant burden for people on long-term oral anticoagulation therapy and can significantly affect both their working and family life.
“Because self-monitoring provides almost instant results, self-monitoring can reduce anxiety, provide a sense of control for the patient and remove the need to frequently attend clinics or hospitals. The Committee also heard that self-monitoring allows people to visit, or act as a carer for, other family members, without having to worry about attending testing appointments.”