Media release

Better systems of care are needed to protect warfarin patients from bleeding

Better systems of care are needed to reduce the possibility of patients prescribed the anticoagulant drug warfarin from suffering medication-related adverse events, according to the authors of a study published in the Medical Journal of Australia.

Research Fellow, Judy Lowthian, from the School of Public Health and Preventive Medicine at Monash University - and her co-authors - conducted an interview-based study of 40 patients using warfarin and 36 of their treating doctors.

Warfarin is the predominant anticoagulant used for protection against stroke in patients with atrial fibrillation and/or mechanical valve replacement.

Despite its effectiveness, warfarin is a major contributor to potentially preventable medication-related adverse events. Each year, between 1% and 7% of patients suffer major bleeding, and 16% with atrial fibrillation experience minor bleeding.

The interviews revealed many patients receiving warfarin therapy also suffered from psychosocial problems, such as cognitive dysfunction, possible depression or not following medication guidelines that may contribute to the risk of medication management-related adverse events.

Not all doctors were aware of these problems in their patients. There were also differing perceptions among the doctors about who was responsible for their patients’ warfarin management. Five of the doctors considered they had sole responsibility for their patients’ anticoagulation, 15 said they had a mutual responsibility with a pathology service and 16 deferred total responsibility to the pathology service.

Principal Investigator, Professor John McNeil, Head of the School of Public Health and Preventive Medicine at Monash University, said there needed to better clarification of which medical professionals were responsible for coordinating warfarin management.

“We propose exploring the possibility of a Warfarin Suitability Score to assist better recognition of patients in whom treatment may be problematic,” Professor McNeil said.

The authors also concluded that consideration should be given to developing a new model of care, for instance involving practice nurses and GPs working together to coordinate treatment and reduce the risk of adverse events.

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA  reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.


CONTACT:   
Prof John McNeil    03 9903 0566 / 0419 300 210

 

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