Patient self-testing of Warfarin
“Traditional provider-based INR monitoring presents barriers to quality warfarin management that include keeping appointments and visits to a laboratory for INR testing. Pending insurance approval, patients may have access to an INR meter while on warfarin. These meters allow for self-testing of INRs, with results discussed with a provider, as well as self-management, in which patients trained in self-testing and well-educated about warfarin and its risks are allowed to adjust their warfarin doses without provider input. It is ACCP’s suggestion that self-management may be used for patients treated with VKAs who are motivated and demonstrate competency in self-management strategies and equipment use (Grade 2B). However, for all other patients, suggested monitoring includes the recommended safeguards (i.e., discussion with their anticoagulation provider).
Studies show that individuals performing self-testing almost weekly have better time in therapeutic range (TTR) than patients undergoing in-clinic testing every 4 weeks using high-quality anticoagulation management (defined as designated, trained staff responsible for patients’ visits and follow-up; using a standard, local procedure at each study site for anticoagulation management) (Matchar 2010). A substudy of this trial also showed that individuals receiving chronic anticoagulation who perform self-testing more often (i.e., weekly or twice weekly) had a modestly higher TTR than with monthly testing (Matchar 2014).
Although the costs of the self-testing meter and supplies are often covered by the patient’s insurance, the poor reimbursement provided to clinic personnel who are making the dose adjustment recommendations often limits provider willingness to offer this service. If this method of reimbursement is not a concern, then patient self-testing can be a way to empower patients to take control of their warfarin management and reduce the burden of frequent outpatient visits.”