Warfarin management in primary care

We read with interest the article entitled “Quality of warfarin management in primary care. Determining the stability of international normalized ratios using a nationally representative prospective cohort” by Liu et al.¹

Ten years ago, our community-based family health team implemented a pharmacist-led, weekly point-of-care (POC) international normalized ratio (INR) clinic. All patients taking warfarin were booked into this clinic for a POC INR measurement and an immediate plan to manage results. In 2013, 2 of our (then) residents did a chart review of patients’ INR results over a 6-month period with usual care of INRs versus the POC INR clinic.² We found a substantial (12%) increase in time in therapeutic range with the POC model. Other advantages of this model included eliminating the lag time between results and management, and providing an opportunity for patients to discuss any new medical issues that could affect INR (such as new medications or illness). While more and more of our patients are taking direct oral anticoagulants, we continue to run our weekly POC clinic. Our clinic is pharmacist led; however, POC testing can also be done by physicians or nurses and nurse practitioners, and is a great learning opportunity for medical residents.

This POC INR model is an alternative that could be considered to further improve INR management in the community.

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