Warfarin management in haemodialysis-are we meeting British Haematology Society standards?

Background: We evaluated current oral anticoagulant management at our main dialysis unit and three satellite units against British Haematology Society (BHS) standards. These standards include patients meeting their target INR 60.5 INR units for 60% of the time with an appropriate frequency of monitoring.

Methods: Data were collected on anticoagulant prescribing and monitoring over one month.

Results: None of the four haemodialysis centres were able to achieve BHS standards for all patients. There was wide variability in monitoring frequency, some patients had 13 INRs and up to 10 dose changes. Satellite C had the most patients (63%) meeting BHS target. Satellite A and B both had 50% of patients meeting target. However, Satellite A, where all patients were dosed by anticoagulant clinic, had the least frequent blood sampling and no patients exceeded the therapeutic INR.

Conclusion: Units that employed dosing by anticoagulant clinics demonstrated best outcome for INR target with the least frequency of sampling. Service design set up and monitoring pathways play a crucial role in achieving warfarin therapeutic targets in haemodialysis units.