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    New study shows warfarin weekly self-testers achieve better control with management by exception protocol

    Photo of Gary LiskaGary Liska

    In a study recently published in Nursing 2014, atrial fibrillation patients on warfarin therapy who self-tested their coagulation (via international normalized ratio [INR]) and were remanaged by their clinicians using a “Management by Exception” protocol had better warfarin control than traditional self-testers.1 The protocol, in which patients followed specific clinic-issued, written instructions for managing out-of-range INR self-test results within a predetermined safety range, also benefited clinics by reducing the need for telephone follow-up and related costs.

    The Management by Exception study complements the findings of the Self-Testing Analysis Based on Long-Term Experience (STABLE) study, first presented at the American College of Cardiology meeting in 2012.2 These findings are to be published on March 24, 2014, in the American Journal of Managed Care. While the STABLE study confirmed that weekly testing was the optimal testing frequency for patients taking warfarin despite their previous stability, the Management by Exception study provides an actionable patient protocol that clinics can implement to make weekly testing viable over the long term.

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