Posted by:Danielle Pouletsos July 26th, 2016

This is a guest blog by Danielle Pouletsos. She completed her BS in Health Science with a concentration in Public Health and Community Health Education in 2005. She earned her Master of Public Health degree at the University of Illinois at Chicago and specialized in Public Health Informatics in 2009. She has worked in the non-profit sector for over 10 years serving those with HIV/AIDS and Developmental Disabilities.

Read more about public health, mhealth and related topics on Danielle’s blog.

This is the part 2 of two series blog. You can read the part 1 here.

As discussed in Part I of this blog series,The Hassle of Anticoagulation Management, Warfarin therapy requires close monitoring and detailed attention not only from providers, but from patients as well. There are many health benefits of Warfarin therapy, but the potential of life-threatening side effects is very real and all too common and many can be prevented, or the severity reduced, with better management and monitoring.

There are numerous variables involved in the management of Warfarin therapy. Recent developments in mHealth introduce a way for patients to take better control of their anticoagulation management and also provide health care practitioners with pertinent information needed to safely adjust the dosage of Warfarin to maintain patients’ INR ranges. Better monitoring with increased information sharing can help prevent negative, life-threatening side effects from occurring and improve patient compliance.

Taking all of this into account, Roche Diagnostics has designed an INR monitor which has Bluetooth connectivity. Having the monitor connected to a mobile application that allows patients to input their own data such as consumption of vitamin K, changes in their diet, medication changes, and activities has tremendous benefits. It will not only streamline Warfarin therapy management, but will also improve patient health outcomes and decrease common negative incidents such as hemorrhaging or stroke.

Having a device that can provide INR results quickly to practitioners without waiting for results from a lab appointment or having to go to the Coumadin Clinic allows the provider to adjust the dosage accordingly and immediately if warranted. This is also a great benefit for people who travel and have difficulties managing their INR due to comorbidities. This innovation has the potential to impact the overall success and efficacy of Warfarin therapy management.


A parallel example that can be provided that many, from laymen to medical professionals, are familiar with is Diabetes management and blood sugar monitoring. Those with Diabetes have had the ability to keep track of their blood sugar levels on a daily basis and get their A1C checked every three months. I am using this as a comparative example because it has given diabetic patients more independence and success when it comes to managing their chronic illness. Not to diminish the severity of Diabetes, but more attention and focus needs to be placed on Warfarin therapy management as well because life-threatening issues can occur rapidly. The dose of Warfarin one would take today impacts the INR in 2-3 days and that needs to be taken into account when managing the dosage. Effectively managing Warfarin therapy involves comprehensive patient education, and the ability of the practitioner to have the foresight to adjust patients’ dosage to keep their INR in the prescribed range.

Patients undergoing Warfarin therapy can sometimes “tell” if their INR is not within the prescribed range, but its subjective. Bruising very easily and an excess amount of bleeding from a minor injury can clue patients in that their INR may be too high. When the INR is too low, the body can show signs such as unexplained headaches, termed “Coumadin headaches” and abnormally low bleeding from an injury.

People who have an INR testing machine already that does not have Bluetooth connectivity can check their own INR, but few practitioners will adjust the Warfarin dose based on those results because the machine can be incorrectly calibrated. Patients should never adjust their dose without consulting their medical provider first. Aside being incorrectly calibrated, other factors are not considered that a mobile application can provide such as dietary changes, intake of vitamin K, medication changes, or anything else that would have an effect on the INR.

With the increasing popularity and development of mHealth, the new INR machine Roche Diagnostics has developed can communicate information to a practitioner and make the management of Warfarin therapy more streamlined and easier for the patient. It is extremely important for patients to know the status of their INR. If it is out of their prescribed range, damaging or even fatal side effects can occur. Having an INR machine with Bluetooth connectivity can transfer data to a mobile app that can send results to the health care provider and link it to an electronic health record, thus making Warfarin therapy more manageable and safer for patients and have other treating physicians know their INR status as well. Having this mHealth technology available can also decrease the already demanding workload of practitioners and prevent duplicate testing.

Easing the difficulty of anticoagulation management can potentially result in less doctor visits, less hospital visits, and decreased instances of serious, or fatal, side effects. Placing patients in control, providing more education on the management of Warfarin, which can be included in the mobile application, and more frequent monitoring of patients’ INRs lowers the risks associated with Warfarin therapy. The simple, and common, example of a patient being sick with fever taking antibiotics and being able to send a health care provider current INR results is a tremendous benefit because infection and antibiotics both effect the efficacy of Warfarin. Typically, hematology/oncology and cardiology specialists monitor anticoagulation management. Reducing the amount of patients coming into the office also reduces the risk of exposure to harmful bacteria to those receiving chemo therapy and are immunocompromised. It also allows these specialists more time to focus on other patients rather than rushing and double, even triple, booking appointments.

The potential of mHealth shown with the sole example of anticoagulation management sheds light on the benefits of this upcoming technology. Better practice, safer management, healthier patients, and improving the continuum of care can only lead to an improvement of patient outcomes. Streamlining Warfarin therapy management with mHealth will lead to a decrease in deaths from mismanaged anticoagulation, decrease the risk of stroke, and also prevent instances of internal bleeding and hemorrhaging. Warfarin is a very beneficial medication that has saved many lives, but has also led to unnecessary deaths which could be prevented with better management and communication between patient and provider.

This is just the beginning of the benefits of mHealth and its capabilities. The improvement of patient outcomes and the continuum of care can only get better with further development and implementation of mHealth technology.

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