Bleeding rate cut in half.


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Warfarin therapy is sometimes withheld from elderly patients because of their overall higher risk of bleeding. Yet less than an hour's worth of patient education in the monitoring of anticoagulation can reduce the risk of bleeding-and it might engender more widespread use of this valuable therapy.


In a recent study, hospitalized patients over age 65 who were receiving warfarin and would continue the drug after discharge were randomly assigned to either an intervention or to the usual care given by the primary physician. The intervention consisted of a 30- to 60-minute session with a lay educator. The educator taught patients the signs and symptoms of bleeding, food and drug interactions with warfarin, and how to monitor prothrombin time (PT) with a portable device. Patients were instructed to call PT results in to the hospital, and investigators made dosing adjustments as necessary.


The number of major bleeding episodes was significantly reduced in patients who participated in the intervention (see Incidence of Major Bleeding, below). The gastrointestinal tract was the most common site of bleeding. Excessive anticoagulation was more common in the usual-care group than in the intervention group.


Beyth RJ, et al. Ann Intern Med 2000;133(9):687-95.



Table. Incidence of ... - Click to enlarge in new windowTable. Incidence of Major Bleeding.