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12-week warfarin assessment noninferior to 4-week assessment
Schulman S. Ann Intern Med. 2011;155:653-659.
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Patients assigned to warfarin may be able to extend the time between international normalized ratio monitoring to every 12 weeks instead of every 4 weeks, according to a single-center randomized study.
The study included 226 patients assigned to long-term therapy with warfarin from a single center in Canada.
The patients were randomly assigned to follow-up monitoring every 12 weeks (n=124) or every 4 weeks (n=126). However, those patients assigned to 12-week monitoring still communicated with hospital staff every 4 weeks and received information about maintaining steady level of blood thinness and warfarin dose.
The main outcome was measuring the amount of time patients remained in the target therapeutic range.
At the end of the study, 74.1% of patients in the 4-week group remained in the target therapeutic range, compared with 71.6% of patients in the 12-week group. Five deaths occurred among patients in the 4-week group, compared with two deaths in the 12-week group.
Researchers pointed out several limitations of the study, including the fact it was conducted at a single center and that the patients assigned to 12-week monitoring still communicated with hospital staff every 4 weeks.
Results may vary in a setting with different physicians, or when patients truly are limited to contact with medical staff once every 12-weeks, researchers said.
“Nevertheless, we believe that these trial findings have potential implications for practice,” the researchers wrote. “If our local experience that one third of patients receiving warfarin can be generalized to the millions of people in the United States currently receiving long-term warfarin therapy, using prolonged test intervals may results in substantial savings.”
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