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Harvard Heart Letter | June 2008
Heart Beat
Warfarin home monitoring program expanded
If you take warfarin (Coumadin) because you have atrial fibrillation or have
had a blood clot in a leg or lung, Medicare will pay for you to check your blood
clotting time at home. This change, announced in March 2008, may save you time
and make taking warfarin safer.
All people who take warfarin must routinely check their INR, a measure of how
long it takes blood to clot. This simple blood test shows whether your warfarin
dose is too low (which could lead to a blood clot), too high (which could lead
to bleeding in the brain or elsewhere), or just right.
Home INR monitors have been on the market since the 1990s, but they cost more
than $1,000. In 2002, the Centers for Medicare and Medicaid Services agreed to
pay for home INR testing for people with artificial heart valves. It has since
vastly expanded the pool of people who can take advantage of this service.
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Testing your INR at home involves pricking your finger with a special lancet,
putting a drop of blood on a test strip, and reading the result from a
meter.
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Compelling research shows that people who check their INR at home are less
likely to have a heart attack, stroke, deep-vein thrombosis, other clot-caused
problem, or serious bleeding episode compared with people who trudge to the
doctor to do this. Some people use their home INR results to regulate their
daily dose of warfarin.
Home INR testing is as straightforward as testing blood sugar at home. Paying
for it isn’t. Instead of covering the cost of the machine and the test strips
for an individual, Medicare requires a doctor or laboratory to buy the equipment
and test strips and “loan” them to patients. Although few doctors are willing to
make this investment, companies such as Raytel Cardiac Services, Quality Assured
Services, and others are making a business out of working with doctors to
provide home INR monitors.
Many doctors don’t know about home INR monitoring. If you take warfarin and
would like to forgo the hassle of trekking to your doctor’s office or a lab
every few weeks for a one-minute blood test, ask if you are a good candidate for
home INR testing.
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