Improving anticoagulation control

North West CoastStroke
Start Date: 1 Mar 2015

Implementation of genotype-guided dosing of Warfarin for atrial fibrillation to improve anticoagulation control.

Project description

Oral anticoagulant (OAC) drugs thin the blood and prevent clots in patients with atrial fibrillation (AF) which is one of the major causes of stroke. Warfarin is the most common drug used. If the dose is too high, the blood might be too thin and risk a bleed and if the dose is too low, there is a risk of stroke because the blood is not thin enough. Trying to find the right amount of Warfarin to suit each patient is difficult and needs to be done in a short amount of time so that patients do not start bleeding or have a stroke. At the moment there is no set effective way of giving patients the most suitable amount of Warfarin for them and much if it is trial and error. Some clinics start with a low dose and work upwards and others start with a high dose and work down. The correct dose is achieved when the blood is thinned to just the right amount and can be meas-ured in the clinic using the test which is called international normalized ratio (INR).

For some people, this process can take a long time and can require many visits to the anti-coagulation clinic. Recent research has shown that some people carry a higher risk of bleeding when taking Warfarin and new genetic tests can reveal who is most at risk. Carrying out this genetic test before prescribing Warfarin can help healthcare professionals to know what the correct warfarin dose is more quickly and stabilise patients on Warfarin.

As part of the delivering personalised health and care theme within CLAHRC NWC, we wish to implement this test as part of the routine clinic visit prior to giving patients with AF Warfarin to improve the time it takes to find the most suitable Warfarin dose. This will reduce the amount of times that patients need to attend hospital, reduce the amount of times that patients experience bleeding side effects, improve the patient experience and help pa-tients to manage their medication better. We want to examine whether the test can be cost effective and find out what staff think about and how it can become part of the routine in clinics.

Prof Munir Pirmohamed