Volume 187 - Issue 6
Management of warfarin in atrial fibrillation
Authors: Peter W Ford and Angela Close
Med J Aust 2007; 187 (6): 371. || doi: 10.5694/j.1326-5377.2007.tb01288.x
Published online: 17 September 2007
Published online: 17 September 2007
To the Editor: Bajorek et al1 did not address two aspects of compliance that may be an issue in community care of patients with atrial fibrillation taking warfarin: time of dose, and point-of-care testing.
There is no pharmacological reason requiring warfarin administration in the evening. This practice arose to facilitate dose adjustment on the day of testing, initially in hospitals, and subsequently flowed on to community care. We know that compliance is better with once-daily administration re-gimens, and this patient group invariably needs other medications, such as diuretics, that require morning doses. Concomitant morning administration of warfarin would be logical. In addition, it would reduce attendances by domiciliary nurses to cognitively impaired patients, who may otherwise require twice-daily visits for administration of medications. This would alleviate a significant burden on this stretched resource.
The implementation of point-of-care testing at the general practitioner’s surgery by a registered nurse can be of great benefit in the liaison required to manage therapy, and facilitates instant dose adjustments by the doctor, who has comprehensive knowledge of the patient’s pharmaceutical and health circumstances.2
References
- Bajorek BV, Ogle SJ, Duguid MJ, et al. Management of warfarin in atrial fibrillation: views of health professionals, older patients and their carers. Med J Aust 2007; 186: 175-180.
- Shiach C, Campbell B, Poller L, et al. Reliability of point-of-care prothrombin time testing in a community clinic: a randomized crossover comparison with hospital laboratory testing. Br J Haematol 2002; 119: 370-375. 0_i1091813