Goal 2: Reduce Human Disease

Need to assess a new method of warfarin management vs. new oral anticoagulants in patients with atrial fibrillation

The two obstacles to warfarin therapy (keeping the INR in range and the associated hassles of frequent lab visits) can be eliminated by INR self testing and online "virtual clinic" monitoring and management (as demonstrated in six small studies. Achieving an INR percent time in range of approximately 75% to 80% is associated with a 50% or lower rate of thromboembolism and major bleeding. The studies of new oral anticoagulants were conducted largely outside of the U.S. in a large number of countries where warfarin management was sub-optimal. Reasonable projections are that warfarin managed with INR self testing and one of the available online virtual clinic systems would be superior to the new agent in terms of safety and efficacy in AF.

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