The practice has published its regular audit of anticoagulation with warfarin for 13 years since April 1996.

In November 2009

82 % of patients are within their target range *

109 patients are taking warfarin.


105 who are on a therapeutic dose, and are monitored in this practice, are audited - 4 are excluded: 2 are managed in hospital, 1 has just started, 1 has defaulted from follow up at 6 weeks.

*Group A (INR 1.9 - 3.0) 84% (n = 98)  *Group B (INR 2.9 - 4.0) 57% (n=7)

Click here for a graph summary: http://www.eyemouthmedicalpractice.co.uk/warfaringraph09nov.pdf

This is lower than the previous (March 2009 88%) audit but is a reassuring statement of the overall safety of the process at present. All patients have duration of treatment and diagnosis recorded. This is the second audit after introducing capillary blood testing in the Health Centre using devices kindly purchased by the Friends of the Health Centre. 81 patients are being tested on capillary blood (19 are having their venous blood collected by the community nursing team - and 2 decline near patient testing (NPT).)

There are several reasons for the difficulty maintaining people in the target range - alcohol binges in at least 1 patient remains unpredictable; over-long intervals are controlled this quarter.

85 % have been within range over the last year

The total number of people on anticoagulants has increased againthis cycle. There were 57 patients taking anticoagulants in 1996, now there are 109. The increase has been steady year on year.

Another way to view long-term stability is by looking at test intervals - 4 weeks and over represents a stable dose for an individual - more 1 week intervals reflect recent instability. In this quarter 66% (71% in March) have been on a stable dose (compared with range 43-66% in recent audits).

Reasons for anticoagulation:                   Atrial fibrillation                                     63%

Pulmonary emboli                                 13%

Prosthetic Valves                                 14%

DVT                                                      5%

Cerebro-vascular disease                       1%

Peripheral vascular disease                    2%

Congenital Heart disease                        1%

Pulmonary Hypertension                         1%

For interest and safety.

  • It is worth keeping at least two vials of Vitamin K in the treatment room for oral use if the INR rises to 7.0.
  • Managing INR decisions needs vigilance for interactions - GLUCOSAMINE, co-proxamol, cranberry juice, paracetamol, ginseng, garlic, and other spices -
  • and always alcohol. 

75% correct INRs remains a sustainable ideal for the Eyemouth team at present.