HomeNews & TopicsHealth Care PolicyPoint-of-Care INR Testing

Point-of-Care INR Testing

Published on

When a group of drugs called the “new oral anticoagulants” or “NOACs” recently became available in Canada, many felt that it would be the end of an era for . Warfarin had been used for over 60 years to prevent blood clots and stroke in patients at increased risk, and it is safe and effective. But dietary restrictions and the need for regular blood monitoring can make warfarin therapy challenging – challenges that don’t exist with the NOACs. However, the NOACs cost significantly more than warfarin even when the cost of blood monitoring is factored in. And clinician and patient experience with the newer drugs is limited.

To help physicians and patients make informed decisions about medications for blood clot and stroke prevention, a review of the medical evidence was needed. And, after all of the medical evidence on warfarin and the NOACs was reviewed by – an independent, evidence-based health technology agency, a panel of experts recommended that warfarin remain the first choice for the prevention of blood clots and stroke in patients with atrial fibrillation. The NOACs were recommended as a second-line option for some patients.

MORE: THE WAR AGAINST SUPERBUGS

But the experts also recommended that to maximize the benefits of warfarin, a structured treatment plan should be followed, including regularly scheduled blood tests to monitor therapy, the use of dosing tools, patient education, and the involvement of caregivers and health care professionals.

CADTH has just completed another research project looking more closely at the issue of regular blood tests to monitor warfarin therapy. When taking warfarin, patients must be monitored to ensure that they are getting the right amount of the medication and are not at risk for bleeding or blood clots. The standard method for monitoring the drug therapy is testing of blood drawn from a patient at a lab to measure the INR (which stands for “international normalized ratio” and is a measure of the time it takes a patient’s blood to form clots). However, point-of-care – testing the blood not at a lab but instead where the patient is already located – is another way of monitoring warfarin therapy.

Point-of-care INR testing is similar to the way patients with diabetes test their blood sugar. A small sample of blood is obtained by pricking the fingertip. The blood is placed on a test strip and inserted into a device called a coagulometer, which analyses the blood and displays the INR result. Point-of-care INR testing provides quicker results than lab testing and can be more convenient for patients and their caregivers by removing the need to travel to a lab. This can be particularly helpful for patients in rural or remote areas who live long distances from lab facilities.

MORE: THE SAFE USE OF WIRELESS DEVICES IN HOSPITALS

Point-of-care INR testing can allow patients to manage their own warfarin dose adjustments using the testing results. This is called “patient self-management.” For patients unable to manage dose adjustments, they could use point-of-care INR testing to get their INR results and then call a health care professional who will then adjust their warfarin therapy as needed. This is referred to as “patient self-testing.” Alternatively, point-of-care INR testing could be used by health care professionals with their patients in a clinical setting such as family doctor’s office or anticoagulation clinic.

After reviewing all of the medical evidence on point-of-care INR testing for patients taking warfarin, an expert panel agreed that point-of-care INR testing is accurate. The experts recommended that patients should be offered, if they are willing and able, the option to test their own INRs and make dose adjustments to their medication.  The panel recognized that these patients will require ongoing education and support to ensure the success of their self-management of warfarin and that quality assurance of point-of-care INR testing is important.

MORE: SELF MONITORING OF BLOOD GLUCOSE IN TYPE 2 DIABETES

The expert panel also recommended that if patients are not willing or able to manage their own warfarin dose adjustments, self-testing of INR with dose adjustments by a health professional may be an option, but only if there are significant barriers to patients having their INR regularly tested in a lab. These barriers might include living in rural or remote areas far from a lab, or mobility issues that make travel  to a lab difficult.

The evidence also showed that using point-of-care INR testing in a clinic setting can be more costly than lab testing. This doesn’t rule out the use of point-of-care INR testing in doctor’s offices or anticoagulation clinics but does mean that careful consideration of a clinic’s context and costs are important when considering implementing point-of-care INR testing.

If you are a clinician, patient, caregiver, or health care decision-maker and would like more information on this project or other health technology assessments, you can find it all free of charge on our website at www.cadth.ca. Our information on warfarin, the NOACs, point-of-care INR testing, and other related topics can also be found at: www.cadth.ca/clots.

Latest articles

Stroke protection and brain health

Every day, millions of people worry about losing their memory, having a stroke, or...

From research to real life: RVH launches innovative tool to empower patient conversations

Royal Victoria Regional Health Centre (RVH) is proud to launch the ASKmeGOC Goals of...

HHS pharmacy sets national benchmark: First-ever delivery of groundbreaking $4.5M Hemophilia B treatment

Hamilton Health Sciences (HHS) outpatient pharmacy recently made history by becoming the first in...

Canada is facing a grief crisis — A new national strategy

Canadian Grief Alliance calls for urgent action to fix Canada’s broken grief support system...

More like this

Indigenous Wellness Centre helping build trust in health care system

It’s a space for the community built by the community. A first-of-its kind Indigenous Wellness...

Joseph Brant Hospital and St. Joseph’s Healthcare Hamilton launch integrated-health information system partnership

Joseph Brant Hospital (JBH) and St. Joseph’s Healthcare Hamilton (SJHH) have launched a new...

Canada must act quickly to turn U.S. ‘brain drain’ into Canadian ‘brain gain’: CMA

By Dr. Joss Reimer Canada must act quickly to attract the American medical and scientific...

THE GROWING BURDEN OF WORKFORCE MANAGEMENT IN CANADIAN HEALTHCARE

As the demand for quality care grows, so does the pressure on healthcare organizations...

The importance of investing in healthcare

The importance of investing in healthcare The second you put the words “shareholders” and “health...

The role of healthcare in mitigating the climate crisis

The role of healthcare in mitigating the climate crisis By Wendy Levinson Canada signed the historic...