It is a sad fact that the protocols in place for monitoring patients on warfarin are inadequate and many patients will be in and out of therapeutic range between lab INR tests and that includes my own mother. I fortunately work closely with my mother's GP who allows me to use the Coaguchek system to monitor her INR closely and with her own GP permission doses are appropriately adjusted.
Unfortunately she is in hospital at present and staff refuse to take account of Coaguchek and insist on weekly lab tests. This is not too drastic a problem, but when one identifies an INR of 4 6 using Coaguchek (betwern lab tests) and no action is taken, then this is a concern. Action had to be taken by myself to addtess issues.
I regret there is a lot of ignorance with certain clinical staff and certainly this is the case with the anticoagulation clinic that I have attempted to reason with. It does not give one any confidence of their management skills when they make dose changes based on what they think the INR would have been in three days hence. The service needs a re-work.