TODAYonline

To strike a balance

Anti-coagulation clinics help patients manage warfarin dosage

Sheralyn Tay
sheralyn@mediacorp.com.sg

It is a delicate balance — too much could cause excessive internal bleeding, too little could lead to fatal clots.

The double-edged sword of warfarin, a drug which thins blood to prevent abnormal clots from forming, means that patients being treated must be closely supervised to ensure an optimal dose.

In Singapore, most of these patients, who may have deep vein thrombosis or have suffered from a stroke, see doctors every three or four months. But international guidelines recommend that patients on warfarin see a doctor every eight weeks.

Many of them, such as Ms Lee Siew Leh, 73, need many tweaks to their dosage if their blood test results fluctuate constantly. With each dosage change, these patients require more blood tests and visits to the doctor.

Now, thanks to a programme by the National Healthcare Group (NHG) polyclinics, that is managed by pharmacists and not doctors, Ms Lee's condition has stabilised.

"In the past, I did not know why my blood test results (to determine blood thinness) kept going up and down," said the lively grandmother. "But slowly, through counselling, I began to understand that the medication is very sensitive (to changes in diet or lifestyle)."

The Anti-coagulation Clinic (ACC), which piloted in April last year at Clementi Polyclinic, was initiated to educate and empower patients such as Ms Lee, said the polyclinic's senior manager of pharmacy practice, Ms Tan Lay Kheng.

"Warfarin monitoring requires deep probing into dietary habits and lifestyle, even sports activity, but it is difficult for a doctor to do this all the time," said Ms Tan. With the ACC, doctor consultations can be "toggled" with visits to a pharmacist, meeting the desired frequency without adding to a doctor's patient load.

According to senior pharmacist Ms Lim Mui Eng, patient feedback has been very positive. "They understand better the consequences if they omit a dose or if they change their diet," she said.

The anti-coagulation treatment has a very high risk-benefit ratio, according to Ms Tan. The closer monitoring at the new clinic has helped to prevent complications, such as internal bleeding, from occurring.

It has also meant time and money saved. Before the ACC, patients averaged 18 polyclinic visits annually, but better management through the ACC has seen the number drop to 11. And because it is cheaper to see a pharmacist, the average bill has also almost halved from $300 a year to about $180.

The ACC programme, which will be presented at the NHG's Disease Management Conference from May 8 to 11, has been rolled out to four NHG polyclinics, Clementi, Hougang, Ang Mo Kio and Toa Payoh, each seeing an average of 100 patients. By October, it will be extended to the Yishun, Woodlands, Jurong, Choa Chu Kang and Bukit Batok polyclinics.