Non-adherence to warfarin: a case study

What is it about?

Atrial fibrillation (AF) is a major risk factor for stroke, requiring monitoring and treatment. If there are no significant risk factors, warfarin therapy may be prescribed for some types of AF, but necessitates compliance, careful monitoring and dose adjustment. This article highlights the pitfalls if clinicians do not consider the wider context of the patient's life, and how lifestyle choices may cause out of range target INRs for patients.

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Why is it important?

Atrial fibrillation (AF) is a major risk factor for stroke, requiring monitoring and treatment. If there are no significant risk factors, warfarin therapy may be prescribed for some types of AF, but necessitates compliance, careful monitoring and dose adjustment. Many factors influence the effectiveness of warfarin therapy, including alcohol consumption, dietary constituents, herbal supplements, and prescribed or over-the-counter medicines. Compliance, in turn, can be affected by factors such as the presence of dementia or cognitive impairment. As exemplified in this case study, a structured approach for the management of warfarin should be adopted, ensuring factors affecting compliance or drug effectiveness may be identified and appropriate action can be taken.