Clinical Outcomes of a Collaborative, Home-Based Postdischarge

Abstract

Warfarin is the most commonly pre-scribed oral anticoagulant world-wide and is likely to remain an important drug into the future, based on its proven efficacy and the lack of cost-effective al-ternatives for indications such as chronic atrial fibrillation.1 Despite almost 60 years of clinical experience with its use, warfarin is still a major cause of adverse drug events and hospital admissions,2-5 and optimal management remains a challenge. Warfarin-related hemorrhagic events6,7 and thromboembolic events re-sulting from therapeutic failures8,9 result in significant morbidity and mortality in individuals and substantial costs to the health-care system.4 A number of factors complicate war-farin management in the period following discharge from the hospital. Adverse event rates are intrinsically higher after warfarin initiation, with bleeding and re-current thromboembolic events occurring more frequently.7,10,11 The requirement for closer international normalized ratio (INR) monitoring early in therapy or be-cause of destabilized postdischarge anti-coagulant control12 often represents a sig-nificant burden for patients with mobility or transportation problems.13 Some pa