Date of Award

Spring 4-23-2015

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Karen Macauley, PhD, DNP, FNP-BC, GNP-BC, Faculty Chair & Clinical Mentor

Second Advisor

Kathy James, DNSc, MSN, BSN, Seminar Faculty


Background: Warfarin is the most commonly prescribed oral anticoagulant for the prevention and treatment of venous thromboembolism. Due to its narrow therapeutic index, warfarin requires close monitoring of the international normalized ratio (INR) to ensure proper anticoagulation control and safety. INRs outside of this range are strongly associated with an increased risk of major bleeding, thromboembolic events, and death. Patient self-testing (PST) using a point-of-care device allows patients to monitor INR results at home. Evidence shows that PST improves the clinical outcomes of warfarin therapy compared to usual care, which includes laboratory INR monitoring. Purpose: To compare the clinical effectiveness of INR patient self-testing in adults on warfarin therapy versus usual care in an internal medicine practice. Conclusions: On average, PST achieved tighter anticoagulation control compared to usual care. PST provided more consistent and less variable INR results within the therapeutic range. These findings are clinically and statistically significant, suggesting the clinical efficacy of PST. Clinical Implications: These outcomes warrant the comparison of different INR meters, in terms of patient choice and satisfaction.