Posted: April 29th, 2018

Evaluating a Warfarin Teaching Program on Patient Knowledge and Time in Therapeutic Range

Evaluating a Warfarin Teaching Program on Patient Knowledge and Time in Therapeutic Range

Warfarin is an anticoagulant medication that prevents harmful blood clots from forming or growing larger. It is used to treat or prevent conditions such as atrial fibrillation, mechanical heart valve, deep vein thrombosis, pulmonary embolism, stroke and heart attack. However, warfarin therapy requires careful monitoring and education to ensure its safety and effectiveness. Patients need to understand how warfarin works, how to take it correctly, what factors can affect its action, what side effects to watch for, and how to manage bleeding or clotting emergencies .

One of the main challenges of warfarin therapy is to maintain the patient’s blood clotting time within a target range, measured by the international normalized ratio (INR). The INR reflects the balance between the risk of bleeding and the risk of clotting. If the INR is too low, the patient is at risk of clotting; if the INR is too high, the patient is at risk of bleeding. The target INR range depends on the patient’s condition and may vary from 2.0 to 3.5. The INR can be influenced by many factors, such as diet, medication interactions, illness, alcohol intake, and genetic variations .

To achieve and maintain a stable INR, patients need to have regular blood tests and adjust their warfarin dose accordingly. They also need to follow certain dietary and lifestyle recommendations, such as avoiding foods high in vitamin K (e.g., green leafy vegetables), limiting alcohol consumption, informing their health care providers of all medications they take (including over-the-counter and herbal products), and reporting any signs of bleeding or clotting .

A warfarin teaching program is a structured, comprehensive, one-on-one education intervention that aims to improve patient knowledge and adherence to warfarin therapy. It covers topics such as the rationale, benefits and risks of warfarin therapy; the mechanism of action of warfarin; the importance of INR monitoring and dose adjustment; the factors that can affect INR; the dietary and lifestyle modifications; the management of side effects and complications; and the communication with health care providers .

The purpose of this study is to evaluate the impact of a warfarin teaching program on patient knowledge and time in therapeutic range (TTR). TTR is a measure of how well the patient’s INR is controlled within the target range over time. A higher TTR indicates better anticoagulation control and lower risk of adverse outcomes . The study hypothesis is that patients who receive the warfarin teaching program will have higher knowledge scores and higher TTR than patients who receive usual care.

The study design is a randomized controlled trial with two groups: intervention group and control group. The intervention group will receive the warfarin teaching program at baseline and at 3 months follow-up. The control group will receive usual care, which consists of verbal instructions from their health care providers. The study population will include adult patients who are prescribed warfarin for any indication and who have an INR target range of 2.0 to 3.5. The sample size will be calculated based on the expected difference in TTR between the two groups, with a significance level of 0.05 and a power of 0.80.

The study outcomes will include patient knowledge and TTR. Patient knowledge will be assessed by a validated questionnaire that covers key aspects of warfarin therapy . TTR will be calculated by using the Rosendaal method, which takes into account all INR values during the study period . The data will be collected at baseline, 3 months and 6 months. The data analysis will use descriptive statistics, t-tests, chi-square tests, ANOVA, and linear regression.

The study results will provide evidence on the effectiveness of a warfarin teaching program on improving patient knowledge and anticoagulation control. The study findings will have implications for clinical practice, policy making, and future research.

References:

: Garcia DA et al., Patient education: Warfarin (Beyond the Basics). UpToDate. Available from: https://www.uptodate.com/contents/warfarin-beyond-the-basics

: A Patient’s Guide to Taking Warfarin | American Heart Association. Available from: https://www.heart.org/en/health-topics/arrhythmia/prevention–treatment-of-arrhythmia/a-patients-guide-to-taking-warfarin

: Warfarin Education Programme | Te Whatu Ora Counties Manukau. Available from: https://www.countiesmanukau.health.nz/for-health-professionals/warfarin-education-programme/

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