Journal of the Hong Kong Geriatrics Society

Volume 11 Number 1, January 2002

Quality improvement program on the control of anticoagulation and complications among Chinese elderly

CK Mok, FC Pang, YF Hong, SY Au

Anticoagulation therapy is indicated in a variety of thrombo-embolic conditions. However, close monitor is required to achieve its therapeutic target and prevent complication of haemorrhage. To achieve that, a quality improvement program was initiated. The purpose of this study is to assess the effect of a quality improvement program on the control of anticoagulation and the complication rate of warfarinized Chinese elderly patients in an outpatient setting. The quality improvement program consisted of defined protocol of medical management and follow up of warfarinized patients according to international standard was implemented. Face to face education of the patients or carers by a trained nurse was al so i ntroduced. The degree of anticoagulation control and the complication rate before and after the program were compared. Nineteen patients of mean age 75.9 were recruited. Better control of anticoagulation was attained after the program. There was significantly less frequent change of warfarin dosage during follow up (50% vs 28%, P < 0.05), significantly less period of hypo-anticoagulation (53% vs 18%, p < 0.01) or any deviation from recommended INR range (64% vs 39%, p < 0.01). However, there were more bleeding episodes, especi al l y maj or ones requiring hospitalization after the program. It is probably because more patients were warfarinized in the higher but recommended target INR range. The suggestion to revise the recommended INR range (3 - 4.5) for mechanical heart valve patients to a lower level is discussed and the literature reviewed. (J HK Geriatr Soc 2002; 11:16-19)

Keywords : Adverse reaction, elderly, Coumarin

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