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Warfarin May Need Less Monitoring for Some
Date:11/14/2011

d to one of two groups: one that received INR monitoring every four weeks or one that was monitored every 12 weeks.

The researchers found that people who were monitored every four weeks had an optimal dose of warfarin 74.1 percent of the time, compared with 71.6 percent for the group monitored every 12 weeks.

"Assessment of warfarin dose every 12 weeks seems to be safe and non-inferior to assessment every four weeks," wrote the study's authors.

"This study contributes a bit to answering the question of how often you have to test, but there was no information on [blood clots] and bleeding events," noted Dr. Jeffrey Berger, an assistant professor and director of cardiovascular thrombosis at New York University Langone Medical Center in New York City. But he added that complications such as blood clots and bleeding are rare events, and to properly assess the risk of these complications with longer monitoring, a much larger trial would be necessary.

He also said, "I think this is a very important study in the current horizon where we have an increasing number of potential alternatives to Coumadin. It's important to understand the tradeoffs between drugs."

The U.S. Food and Drug Administration has approved two alternatives to warfarin: dabigatran etexilate (Pradaxa) and rivaroxaban (Xarelto). And Berger said that another drug, apixaban (Eliquis), will likely be approved soon.

The newer medications don't require monitoring of the dosage, but they are significantly more expensive than warfarin. In Canada and the United States, warfarin costs about 10 cents per day, while Schulman said that a newer medication can be as much as $3.60 a day.

Still, Berger pointed out that without the cost of monthly monitoring, the newer drugs may end up being more cost-effective.

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