http://circ.ahajournals.org/content/126/5/e52.short
Until recently, most patients taking warfarin (brand name
Coumadin) had to visit a laboratory and/or clinic every few weeks
for an international normalized ratio (INR) blood
test and adjustment of their warfarin dose. It is now possible for a
patient
to measure his/her INR (self-testing) with a
finger-stick drop of blood with use of a small, portable,
battery-powered device.
Some self-testing patients adjust their dose of
warfarin (self-dosing) based on a set of instructions. Even more
recently,
online systems have been developed to facilitate
and improve self-testing and self-dosing. Patients who use self-testing
have
described it as life changing. A video on the ease
and benefits of self-testing by a physician-patient named Dr Michael
Schwartz
can be viewed on ClotCare at
www.clotcare.org/inrselftestingvideo.aspx.
Does Self-Testing Offer Benefits Beyond Ease and Convenience?
Yes. The additional benefits are why
Medicare and other insurance companies started paying for self-testing
for most patients
in March 2008. To understand the other potential
benefits, however, one needs some background information. Warfarin is
used
to prevent blood clots that cause strokes, heart
attacks, or other life-threatening conditions. If the dose of warfarin
is
too small, the INR will be low, and a patient
may get a blood clot. If the dose is too large, the INR will be high,
and a
patient may develop a bleeding problem. In most
cases, an INR between 2 and 3 indicates that the warfarin dose is about
right.
In one large study,1 the risk of stroke caused by a blood clot increased 3 to 4 times when the …
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