Warfarin study earns Internal Medicine Center a Banner Philanthropy grant
TREATMENT and prevention of blood clots with the blood thinner Warfarin (commonly known as Coumadin) is common, but not always precise. Too low of a dosage places the patient at risk for developing clots, whereas too high of a dosage may hinder the patient's blood from coagulating properly.
A 2005 Philanthropy Award from Banner Health Foundation will allow physicians at the Banner Good Samaritan Internal Medicine Center (IMC) to develop a system that will track and regulate patients' blood international normalized ratio (INR) — a standard measure of anticoagulation.
"Warfarin therapy is a fact of life for many patients and their physicians," said Mary Ellen Dirlam, MD, Medical Director of the IMC, and primary investigator. "It is a drug with great value in the treatment of clots, pulmonary embolism, atrial fibrillation, prosthetic valves and any medical process that requires an anticoagulant. One of the challenges is to obtain and maintain a therapeutic INR."
The current practice at the IMC is to have the patient go the laboratory for blood draw. The results are available 24 hours later. The patient then is contacted for adjustment of medication. "Obviously we are always playing 'catch up,' " Dr. Dirlam said. "Our question is: how can we develop a system that enables the physician to determine the appropriate dosage of Warfarin in 'real time' while the patient is in the office."
This grant will allow the IMC to develop its database of patients. Staff will be assigned to follow the patients currently on anticoagulation medication and to monitor their INRs regularly. Appointments will be made for patient to check their INR on a routine or as needed basis. The staff will also observe if the dosage is within therapeutic limits and, if not, adjust the dosage according to predetermined protocol while patient is in the office. Patients will be monitored for six months and their laboratory results compared to the previous six months INRs to see if the new protocol is successful in maintaining appropriate INR range consistently. Additionally, any adverse events such as bleeding or development of new clots will be documented.
"The development of the process should provide better patient outcomes by avoiding over-coagulation (i.e. bleeding complications) or under-coagulating (i.e. increased risk for thrombosis or embolism)," said Dorothy Garcia, Administrative Director for the IMC. "Not only will the process enhance patient care, but will also enhance the education of the support staff."
