Impact of Home Testing on INR Control and Adverse Events in Black Patients on Warfarin for Atrial Fibrillation or Venous Thromboembolism
Document Type
Conference Proceeding
Publication Date
5-2025
Publication Title
Research and Practice in Thrombosis and Haemostasis
Abstract
Introduction: Black patients on warfarin have higher rates of stroke, major bleeding, and death compared to White patients. Suboptimal warfarin control, reflected by lower time in therapeutic range (TTR), may contribute to these disparities. Home INR testing has shown mixed results in improving TTR and reducing adverse events (AEs), with limited evidence on its impact in Black patients. Our objective was to compare INR control and AEs between Black home-testers and non-home testers on warfarin for atrial fibrillation (AF) or venous thromboembolism (VTE). Methods: From the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) registry, Black patients on warfarin for AF or VTE between April 2012 and July 2024 were identified. Patients without at least 3 months of follow-up were excluded. Patients without documented home-testing were classified as non-home-testers while patients with ≥3 months of consecutive home testing were classified as home-testers. Home-tester outcome rates were calculated for the home-testing period only. Outcome rates were adjusted by inverse probability weighting, and comparisons were made using negative-binomial model. Major bleeding was based on International Society on Thrombosis and Haemostasis criteria. Results: 122 home-testers and 1086 non-home-testers were compared. Home-testers had a higher TTR (58.8% vs 55.4%, p < 0.01) and fewer nonmajor bleeds (23.1 vs. 33.1 per 100 pt-yr, p=0.024). Major bleeding and thrombotic event rates were similar between the groups. Conclusion: Home INR testing was associated with better INR control and less non-major bleeding in Black patients. Enhanced support for Black patients may further improve outcomes and bridge the gap in anticoagulation care quality.
Volume
9
Issue
Suppl 1
First Page
102788
Last Page
102788
Recommended Citation
Rajakumar B, Kong X, Haymart B, Kaatz S, Krol G, Ali M, et al. Impact of home testing on INR control and adverse events in Black patients on warfarin for atrial fibrillation or venous thromboembolism. Res Pract Thromb Haemost. 2025 May;9(Suppl 1):102788. doi: 10.1016/j.rpth.2025.102788
DOI
10.1016/j.rpth.2025.102788
Comments
Anticoagulation Forum 18th National Conference on Anticoagulation Therapy, April 3-5, 2025, Washington, CD