Warfarin therapy and PT/INR monitoring. A guide to a few things you need to know

Transcription

1 Warfarin therapy and PT/INR monitoring A guide to a few things you need to know

2 What you should know about anticoagulation therapy and warfarin Your healthcare provider says you need anticoagulation therapy with warfarin to prevent serious medical problems, such as stroke, heart attack, or problems in the legs or lungs. 1 Warfarin is the most widely used blood thinner in the world. 2 The goal of warfarin therapy is to maintain the ideal thickness of your blood. As part of your therapy, your healthcare provider will routinely test your blood to identify your prothrombin time (PT), reported as an International Normalized Ratio (INR). This test shows how quickly your blood clots while you are taking your current dose of warfarin, which helps determine if any changes are needed in your dose. 10 Why is monitoring your PT/INR important? The higher your PT/INR, the higher your risk of bleeding 1 For most patients, the target PT/INR range will be INR Target Range 1 0 The lower your PT/INR, the higher your risk for a blood clot 2 Regular tests keep your warfarin dosage on target Many healthcare providers rely on a CoaguChek XS System for in-office tests (and recommend the CoaguChek XS System for patients who self-test) to provide immediate PT/INR results. CoaguChek XS systems provide accurate, reliable results in just one minute, requiring just 8 microliters of blood. Your doctor will decide which warfarin dosage, testing schedule and monitoring method is right for you. See page 14 for more information. 2 3

3 Many factors can affect your PT/INR As with most medications, it s important to understand how warfarin might interact with anything else you consume whether you consume it only once in a while or every day. Three important factors to consider are Vitamin K, alcohol and other medications or supplements you take. Common foods high in Vitamin K: 4 Asparagus Broccoli Brussels sprouts Cabbage & bok choy Collard greens Endive Green onions Kale Lettuce Mustard greens Parsley Soybean oil Soybeans Spinach Turnip greens A few surprising sources of high Vitamin K levels: 5 Baked graham-cracker pie crusts Black-eyed peas (cowpeas) Canola oil Egg noodles made with spinach Olive oil Mayonnaise Prunes (stewed) Some salad dressings Some spaghetti/marinara sauces Vitamin K The #1 dietary concern is Vitamin K. Produced by your body as part of the clotting process, Vitamin K is also found in many foods. High amounts of Vitamin K can reverse warfarin s blood-thinning effect. Does this mean you should reduce your dietary intake of Vitamin K? No. Your doctor will base your recommended warfarin dose on your regular diet. So the key to maintaining an effective dosage level is to tell your doctor about all the foods you usually eat, then be sure to consistently follow your normal eating habits as much as possible. 4 5

4 Alcohol The factors that help your blood to clot are made in the liver, which is also responsible for breaking down any alcohol you drink whether it s beer, wine or spirits. Even if you drink in moderation and only occasionally, alcohol can increase your PT/INR. Binging on a large number of alcoholic drinks over a short period of time can cause gastrointestinal bleeding that can be hard to stop. Therefore, your healthcare provider will likely recommend that you avoid drinking any alcohol while you are taking warfarin. 4 Drugs and supplements Because warfarin can interact with many drugs and supplements, 1,4,6 tell your healthcare provider about everything you take (and consider recording them in a diary or journal), especially if they are on this list: Acetaminophen (e.g., Tylenol ) Aspirin, including ointments/creams Ibuprofen (e.g., Advil ) Naproxen (e.g., Aleve ) Non-steroidal anti-inflammatory drugs (NSAIDS) Heartburn or acid reflux medicines (e.g., Nexium, Zantac ) Cold/allergy medicines Antibiotics Herbal supplements (e.g., Ginkgo biloba, ginseng, St. John s wort) Birth control pills Vitamin supplements with Vitamin K 6 7

5 Making PT/INR monitoring more convenient with Patient Self-Testing (PST) Patient Self-Testing (PST) allows patients to test from home, the office or virtually anywhere* they happen to be. PST can provide a more convenient and, potentially, more effective means to perform your PT/INR tests. So if you have been on warfarin for at least 90 days and your testing schedule conflicts with travel, work, school or access to transportation, PST provides you with the power and convenience to test on your terms. Benefits of PST Convenience test when you need to, wherever* you are Consistency your results are not likely to vary a lot from tests your healthcare provider would perform in the office using a CoaguChek meter More time in-range 7 timely dosage adjustments from your doctor may result in more time in range * Do not use at an altitude above 14,000 feet (2.5 miles). 8 9

6 Self-testing with the CoaguChek XS system for PST The same easy-to-use CoaguChek XS meter technology that healthcare professionals trust to give them fast, accurate PT/INR test results is available for patient selftesting. CoaguChek is the leading brand of point-of-care PT/INR testing technology,* and unlike other meters available for home testing, the CoaguChek XS system for Patient Self-Testing is never pre-owned. In addition, the CoaguChek XS meter is the only PT/INR meter to receive the Arthritis Foundation s Ease-of-Use Commendation. With a CoaguChek XS meter, you can test according to your physician s instruction with a simple fingerstick and enjoy the freedom to live your life while being more actively engaged in your healthcare. Self-testing with the CoaguChek XS meter is simple: 1 Place a test strip in the meter and it automatically turns on. 2 Prick your finger and place a drop of blood on the strip. Large display and one-button operation make testing easy. 3 Get accurate results in about one minute. * More CoaguChek test strips are sold for point-of-care anticoagulation monitoring than all other brands combined

7 Other benefits include: Small, portable meter Easy fingerstick test Top- and side-dosing options One-button operation Large display screen Reimbursable* 300-value memory Convenience Heparin-insensitive test strips Makes testing on the go easy and convenient Requires only a small blood drop Provides flexibility to make blood application simple Simplifies use Reduces the chance of misreading results Limits out-of-pocket expenses through insurance or Medicare reimbursement* Stores test results for peace of mind Delivers test results in about one minute Can provide accurate results even if you are temporarily taking warfarin and low-molecular-weight heparin at the same time 9 *Consult your health insurance plan for details about reimbursement. When I first heard we were going to be able to test Dan s INR at home I thought, wow, one or two less trips a week in the car. You welcome anything that will make your life more normal. Tammy Henning, wife and caregiver, CoaguChekT XS system user 12 13

8 Is PST right for you? Patient Self-Testing begins with a conversation with your physician because PST requires a prescription. If you and your physician agree that PST is a good fit, you will be directed to a PST meter supplier and training will be arranged. Upon successful completion of your training you will be up and running able to perform PT/INR tests at your convenience. PST does not eliminate direct contact with your healthcare providers. Test results must be reported by phone or online as scheduled and office visits are still required as directed by your physician to make therapy adjustments based on your reported results. But PST, if properly administered, can provide a more effective, convenient approach to managing your anticoagulation therapy by receiving more timely dosage adjustments from your healthcare provider over the phone and, ultimately, spending more time in your target range. You re an ideal candidate for PST if you are: Under the care of a physician who will prescribe a PST system and monitor your anticoagulation therapy Committed to following your physician s recommendations for testing frequency and reporting procedures or have a reliable caregiver to help you Finding it inconvenient to make it to your INR testing appointments (e.g., due to frequent travel, conflicts with work and/or school schedules, live far from an office or lab or because you depend on others for assistance and/or transportation) Taking multiple medications 10 Testing frequently (e.g., weekly) due to serious medical condition(s) Having difficulty with frequent venous blood draws (if you are currently tested at a lab) Unable to tolerate side effects from other anticoagulants Talk to your healthcare professional today to discover how self-testing with the CoaguChek XS System can help you feel confident in your treatment and in control of your life again

9 CoaguChek Patient Services can be your Patient Self-Testing partner CoaguChek Patient Services was created with the specific purpose of helping people like you enjoy the freedom of testing your PT/INR from home. You can think of CoaguChek Patient Services as your partner in self-testing. As your partner, we re here to support you and your healthcare team. How? By helping to make it easy for you to perform self-testing on a schedule as prescribed by your healthcare provider. This starts with face-to-face training on your CoaguChek XS meter, and continues with our system for keeping your healthcare team up-to-date on your ongoing progress as well as alerting them of out-of-range PT/INR results, which may suggest that your warfarin dosage should change. You can also rely on CoaguChek Patient Services to: Deliver all the testing supplies you need on a regular basis (order online or by calling our 800-number) Submit all insurance reimbursement claims on your behalf Provide 24/7 technical support for your CoaguChek XS meter Help keep you up-to-date on news about warfarin therapy and PT/INR testing through an informative newsletter and web content Not actual patient Before CoaguChek, I had to test in a lab with a blood draw 1-2 times per week. Waste of time and gas! With CoaguChek, I can test at work/home and not lose valuable time. Bravo to you! Female, months with CoaguChek Patient Services 16 17

10 CoaguChek Link: A smart way to stay connected Enrolling with CoaguChek Patient Services Enjoying the benefits of a partnership with CoaguChek Patient Services is easy. Just call us at and we ll contact your healthcare provider for the prescription information we need to start your enrollment process. We ll even verify your insurance benefits to estimate your out-of-pocket costs.* (We provide insurance verification as a courtesy to you with no obligation for you to enroll.) After you are enrolled with CoaguChek Patient Services, you can choose one of three methods for reporting your results: Online at (requires internet access see next page for details) or Enter your results using the buttons on your phone or Operator-assisted by phone For more information about how CoaguChek Patient Services can help make it easy for you to perform self-testing, ask your healthcare provider or visit * PT/INR testing at home is covered by Medicare and many insurance plans for patients on long-term warfarin therapy due to chronic atrial fibrillation, venous thromboembolism or mechanical heart valve. Reimbursement depends on a number of factors and varies by payer/plan. If you prefer the flexibility and convenience of using a computer, tablet or web-enabled smartphone to help manage your warfarin therapy, is the smart place to be. At you can:* Report your INR test results securely, where they can be accessed right away by CoaguChek Patient Services and your healthcare provider, who will contact you to make therapy adjustments if needed Review all your INR results whenever you like Quickly order testing supplies Update your personal information if it changes Point. Click. Enter your INR test results. It s that easy to stay connected with your healthcare team at It s fast and easy to order all your testing supplies online at * Note: This service is available only for patients who self-test with the support of CoaguChek Patient Services

11 References 1 Coumadin (warfarin sodium) [package insert 293US11PBS01503]. Princeton, NJ: Bristol-Myers Squibb; Wardrop D and Keeling D. The story of the discovery of heparin and warfarin. British Journal of Haematology. 2008;141: Steciuk M, Tichenor P, Marques M. A Simple Tool to Educate Laboratory Staff About Anticoagulation. LABMEDICINE (11): Blood Thinner Pills: Your Guide to Using Them Safely. Agency for Healthcare Research and Quality, Rockville, MD. August Available at Accessed March 14, USDA. USDA National Nutrient Database for Standard Reference, Release 25, Vitamin K Content of Selected Foods. Last modified September Accessed July 25, Mayo Clinic. Warfarin side effects: Watch for interactions. Available at mayoclinic.com/health/warfarin-side-effects/hb Accessed June 12, Körtke H, Minami K, Breymann T, et al. INR self-management after mechanical heart valve replacement: ESCAT. Z Kardiol. 2001;90(suppl 6) GHX Market Intelligence. Data on file at Roche Diagnostics. 9 CoaguChek XS PT Test [package insert (01)]. Indianapolis, Ind: Roche Diagnostics; Douketis J, Patient self-monitoring of oral anticoagulation therapy: American Journal of Cardiovascular Drugs. 2001;1(4): For more information call , or visit coaguchekpatientservices.com. If you want to perform PT/INR self-testing, ask your healthcare provider for a CoaguChek Patient Services prescription today.* * A self-testing option is available only if you have been taking warfarin for at least 90 days. COAGUCHEK is a trademark of Roche. All other product names and trademarks are the property of their respective owners Roche Roche Diagnostics 9115 Hague Road Indianapolis, IN