A Program To Prevent Bleeding Complications in Older Patients Taking Warfarin FREE

Warfarin (sold under the brand name Coumadin) is a medicine that interferes with blood clotting. Warfarin can prevent some conditions that result from blood clots, such as stroke, pulmonary emboli (blood clots in the lung), and deep venous thrombosis (blood clots in the legs). People taking warfarin need careful monitoring with blood tests to be sure that the dose being given reduces the blood's ability to clot enough to prevent clots from forming, but not so much that bleeding occurs spontaneously. Serious bleeding (for example, into the digestive tract or into the brain) can occur when warfarin levels are too high. Many doctors' practices and hospitals have set up special programs to monitor patients taking warfarin, but little is known about how well these programs work.

To see whether a special program for patients taking warfarin decreased warfarin-related bleeding complications.

325 patients 65 years of age or older who started warfarin therapy during a hospitalization at a teaching hospital in Cleveland, Ohio.

The researchers assigned patients at random to either the special warfarin program or to usual care by their personal physicians. The program included patient education about warfarin, training to increase patients' participation in monitoring (including use of a home blood test), and warfarin dose adjustments by the researchers according to guidelines. The researchers then followed patients to see who developed bleeding complications and how often a patient's warfarin levels were in the appropriate range over the next 6 months. They also collected information about death and any new episode of a condition associated with blood clots.

After 6 months of taking warfarin, 12% of patients in the usual care group experienced a bleeding complication compared with only 6% in the special program. Patients in the special program had warfarin levels in the appropriate range more often than did patients in the usual care group. There was no difference between the groups in death or new episodes of a condition associated with blood clots.

The study was done at a single hospital, and its results might not apply in other settings. In addition, it cannot tell us whether the costs of the special program are worth the observed benefits.

A special program for warfarin management that includes patient education, patient participation, home blood testing by patients, and warfarin dosing according to guidelines can decrease the frequency of bleeding complications in patients 65 years of age or older who take warfarin.

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The summary below is from the full report titled “A Multicomponent Intervention To Prevent Major Bleeding Complications in Older Patients Receiving Warfarin. A Randomized, Controlled Trial.” It is in the 7 November 2000 issue of Annals of Internal Medicine (volume 133, pages 687-695). The authors are RJ Beyth, L Quinn, and CS Landefeld.