65. Research study looking at improving safety and quality of life for patients on warfarin (368)

Anita Hanson, Research Nurse, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
Co authors:  Diane Van Eker, Karen Hawkins, Lisa Stevens & Professor M.Pirmohamed
A.Riley@liv.ac.uk

Abstract:

Background:

Warfarin is the anticoagulant of choice in the UK for the treatment of thromboembolism and as prophylaxis for mechanical heart valves and atrial fibrillation. Currently 1% (600,000) of the population of the United Kingdom are on warfarin. Over the last five years the numbers have doubled and the trend is set to continue (Hirri and Green, 2002). Despite the efficacy of warfarin, the drug has the potential to produce adverse reactions and cause fatal consequences if therapy is not monitored adequately (DOH, 2004). The Major risk of warfarin is haemorrhage: the incidence varies from 10-12 episodes per 100 patients of all bleeds, with 1.2-7.0 episodes per 100 of major bleeds (Lip et al. 2002)

Aim:

To evaluate both genetic and environmental factors that affect how patients respond to warfarin. Objective: To develop a clinically useful algorithm that will help to individualise warfarin therapy.

Design:

Using a prospective multi centred study design, 1007 patients commenced on warfarin have been recruited from a cohort in three NHS Trusts in Liverpool. 30 of the recruited patients and 10 anticoagulation health professionals have taken part in qualitative interviews conducted by the University of York, to examine clinician and patient acceptance of pharmacogenetic testing. Recruitment of 400 patients from a primary care setting in Birmingham is nearing completion.

Discussion:

The potential benefits of this would be to:

  • Improve the safety of warfarin therapy
  • Improvement in patient quality of life 
  • Improvement in cost effectiveness of warfarin therapy
  • Improve the uptake of warfarin, particularly for atrial fibrillation.

Source of Funding:  N/A

Amount in Funding:  N/A

Recommended reading list:

• Hirri, M.H. and Green, J.P. (2002) Audit of anticoagulant therapy and acute hospital admission Clinical and Laboratory Haematology. Vol 24. 43-45
• Department of Health (2004) Building a safer NHS for patients: Improving medication safety DOH, London
• Lip, H.Y.G. Hart, G, D. and Conway, G.S.D. (2002) Antithrombotic therapy for atrial fibrillation British Medical Journal. Vol 325. 1022-1025

Biography:

After completing my nurse training at John Moores University in 1998, I was fortunate enough to experience working voluntary for approximately 5 months in Namibia. On returning from Africa, I commenced a position as a staff nurse in orthopaedics. After a couple of years I decided to work in primary care as a district nurse, but then fell in to a position in commercial research working for a contract research organisation. I gained a lot of experience here but wanted to utilise the skills in an NHS environment. I was successful in gaining the position as research nurse in Pharmacology, a very exciting field of work involving the study of adverse drug reactions. I have now worked in the department for nearly five years.