Effect of warfarin education on patient knowledge and anticoagulation control: a randomised controlled trial

Abstract

Background Patient education is a key component of management in the anticoagulated patient. Aim The aim of this study was to establish whether reiteration of warfarin education in the outpatient setting affects patients’ knowledge of warfarin and anticoagulation control. Methods The study was a randomised prospective trial. Participants newly commenced on warfarin at The Royal Melbourne Hospital were randomised to either standard inpatient education (n = 19) or to receive an additional comprehensive warfarin education session (n = 21). The primary outcome was warfarin knowledge as assessed by the Oral Anticoagulation Knowledge (OAK) test. Secondary outcomes were time in therapeutic range (TTR) and complications. The duration of follow‐up was 6 weeks. Results There were no significant differences between the intervention and control groups in OAK test scores (16.3/20 vs 14.4/20, respectively; p = 0.07), TTR (56.9% vs 59.3%, respectively; p = 0.09) or in the incidence of complications. Conclusion Within the limitations of a single‐centre, underpowered study, we did not detect any significant additional benefit to patient knowledge from further outpatient warfarin education. Current standard inpatient education at our centre compared favourably with other such designed interventions outlined in previous studies. Nevertheless, it is possible that certain subsets of the population may benefit from additional education, such as those with mild cognitive impairment and those from non‐English‐speaking backgrounds; however, a much greater sample size would be required to study these groups.

The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy

“…A “weak” global rating would result if 2 or more weak component ratings existed. Among the 14 studies involved in the literature appraisal, 5 were graded as “weak” because confounders, blinding, or data collection methods were either unreported or poorly controlled and the rates of participation or dropout were unsatisfactory 38–42 . Therefore, these studies were excluded.…”

“…Among the 14 studies involved in the literature appraisal, 5 were graded as "weak" because confounders, blinding, or data collection methods were either unreported or poorly controlled and the rates of participation or dropout were unsatisfactory. [38][39][40][41][42] Therefore, these studies were excluded. Falamić et al 43,44 conducted separate analyses of the same study, and these studies were then grouped in the data extraction.…”

Hematology‐led, software‐assisted warfarin dosing vs. manual dosing in hemodialysis patients

“…One small non-randomized trial of nurse-led education reported a 22% improvement in TTR, whereas another small RCT investigating the benefit of education in patients taking warfarin, vs. usual care, was negative in terms of improvement in TTR. 9,10 Given the underwhelming results with warfarin therapy in hemodialysis cohorts to date, we believe that a more widespread implementation of software-assisted dosing in hemodialysis patients could have a role in highlighting the importance of TTR monitoring and ultimately lead to improved outcomes, mirroring those in the general population. Software-assistance allows for instant access to a patient's TTR, which can be more easily tracked and audited.…”