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Comparative Study
. 2008 Oct;23(10):1589-94.
doi: 10.1007/s11606-008-0708-8. Epub 2008 Jul 10.

Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events

Joshua P Metlay  1 , Sean Hennessy, A Russell Localio, Xiaoyan Han, Wei Yang, Abigail Cohen, Charles E Leonard, Kevin Haynes, Stephen E Kimmel, Harold I Feldman, Brian L Strom
Affiliations
Comparative Study

Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events

Joshua P Metlay et al. J Gen Intern Med. 2008 Oct.

Abstract

Background: Adverse drug events are an important cause of preventable hospitalizations.

Objective: To identify whether patient report of receipt of medication instructions and markers of complex care (multiple physicians, recent hospitalization) predict the risk of serious bleeding for older adults on warfarin.

Design: Prospective cohort study of older adults.

Participants: Subjects filled new or refill prescriptions for warfarin at the time of enrollment.

Measurements: Hospitalizations were identified through a state-wide registry. Discharge summaries of hospitalizations for possible warfarin related bleeding events were reviewed by trained abstractors and clinical experts. Incidence rate ratios (IRR) were estimated based on person-months of exposure using Poisson regression models.

Results: From March 2002 through May 2003, we enrolled a total of 2346 adults on warfarin. Over a two-year follow-up period, there were 126 hospitalizations due to warfarin-related bleeding (4.6 hospitalizations per 100 person-years of exposure). Patients who reported receiving medication instructions from either a physician or nurse plus a pharmacist had a 60% reduced rate of subsequently experiencing a serious bleeding event over the next 2 years (adjusted IRR 0.40, 95% CI 0.24-0.68). Having > or = 4 physicians providing medication prescriptions over the last 3 months and filling prescriptions at > 1 pharmacy over the last 3 months were independently associated with increased bleeding rates (adjusted IRRs 2.37, 95% CI 1.22-4.57 and 1.61, 95% CI 0.97-2.67, respectively).

Conclusions: The rate of warfarin-related hospitalization for bleeding is substantially lower for patients who report receiving medication instructions from a physician or nurse and a pharmacist.

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