1. Aug, 2016

2. Mobile Applications in Warfarin Dose Adjustment
Habibollah Saadat, MD Professor of Cardiology, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Aug, 2016

3. Mysterious past Glorious present Challenging future
Aug, 2016

4. sweet smell but bitter taste
Sweet clover
sweet smell but bitter taste
Systematic Name
(RS)-4-hydroxy- 3-(3- oxo- 1-phenylbutyl)- 2H- chromen- 2-aone
Aug, 2016

5. Long-Term Oral Anticoagulation The State of the Art
Wisconsin Alumni Research Foundation + Coumarin = WARFARIN
1920
1941
1954
Aug, 2016

6. Reasons for Prescribing Warfarin
Patients need to know why they need to be prescribed
warfarin, and the consequences of not taking.
The main indications for oral anticoagulation are:
Deep Vein Thrombosis
Pulmonary Embolism
Atrial Fibrillation
Mechanical Heart Valves
The NPSA recommends when telling patients what warfarin
does we use the phrase:
“Makes your blood take longer to clot”
Consequences include further VTE, stroke and death
So as clinicians you need to explain what the diagnosis is and why it is necessary to treat with an anticoagulant
Aug, 2016

7. Monitoring Requirements for Warfarin
Patients need to be told the importance of having their INR measured
Patients should be made aware of what their INR range is and what it signifies
Recommended INRs are:
Indication
INR range
INR target
DVT
2 – 3
2.5 PE
2 - 3
Recurrent VTE whilst on warfarin
3 - 4
3.5 AF
Mechanical valves
Typical target is between
2.5 and 3.5
Aug, 2016

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9. Quality of Warfarin Management in the United States is Poor
Aug, 2016

10. Reference:
Aug, 2016

11. 2012 National Patient Survey
*30% of patients said they did not have the purpose of their medicines fully explained to them in a way they could understand
*60% of patients said they were not fully told about which side effects to watch out for
Aug, 2016

12. Monitoring of Warfarin INR Challenges With Conventional Laboratory Testing
Aug, 2016

13. Limitations of Warfarin (VKA)
Anticoagulation Clinics
Requires frequent monitoring
? Genotype testing
Narrow
Therapeutic
Index & Drug/Diet
Interactions
Complicates management of:
Bleeding patient
Patient with High INR
Long
Half-Life
Slow
Onset of
Action
Heparin “overlap”
often necessary
Periprocedural Anticoagulation Difficult
Aug, 2016

14. Timeline AC management clinics Warfarin become increasingly prevalent
first used
POC testing, PST,
dosing algorithms,
software programs,
better understanding of
genetics and drug interactions
WHO endorses INR
1950’s
1991
1999
1983
Efficacy of VKA
to prevent AF-related stroke
demonstrated
Aug, 2016

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19. Anticoagulation Management Service Can Increase Time-in-Range
% of patients
% time in range
Aug, 2016
Witt et al. Chest 2005.

20. Anticoagulation Management Services
Resource-intensive
Only available to a minority of patients in many countries (including the United States)
Aug, 2016

21. Patient Self-Management Reduces Risk of Thromboembolic Events
Similar trend for bleeding…
Aug, 2016
Heneghan et al. Lancet Feb 4;367(9508):

22. Why Home Monitoring Achieves Better Outcomes
Aug, 2016

23. Point of care coagulation monitoring
It is estimated that over 10 million people are taking warfarin and more than 200 million PT-INR tests are conducted each year worldwide.
The point-of-care coagulation monitoring market is estimated to be worth approximately US$1 billion globally with point-of-care PT-INR testing making up over 65% of this market.  
Aug, 2016

24. Point of care coagulation monitoring
Aug, 2016

25. Point of Care Diagnostics
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26. Benefits of POC INR Monitors
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31. Advantages of mobile Apps
Interactivity
Personalization
Complex Calculations or Reporting.
Native Functionality or Processing Required.
Internet Connection is Not Always Required.
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35. Conclusions
Although Warfarin treatment is safer and more practical than it was years ago, there is certainly room for further improvement
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