Warfarin user campaigns for blood thickness self-monitoring

Anti-coagulants: Ellen Feeney, who has been on the anti-coagulant - or blood-thinning - medication warfarin for over 20 years…

Anti-coagulants: Ellen Feeney, who has been on the anti-coagulant - or blood-thinning - medication warfarin for over 20 years, believes the Government is missing an opportunity to save millions of euro and to save the estimated 40,000 other patients like her hundreds of hours.

Her consultants, the Irish Medical Organisation (IMO) and a number of TDs agree with her.

Speaking from her home in Galway yesterday Feeney explained how patients on warfarin must have their blood "thickness" monitored regularly to ensure they are not at risk of a haemorrhage or a clot.

She has been on the medication since a blood clot in 1984 resulted in a small stroke and she had to have a mitral valve in her heart replaced.

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Most people on warfarin in this State must attend either an A&E department, an outpatient clinic or, if they are lucky, their GP for a regular blood test. Their warfarin dose can be adjusted if the results demand it. The test is needed monthly, fortnightly or even weekly - requiring nearly a day in a hospital for some.

Feeney, however, tests herself at home with a machine she purchased for a little over £400 (€588).

"In 2001 my son, who was working in London, picked up a copy of the Daily Telegraph and there was a page offering aids for various illnesses." Among them was a Coagucheck S System machine.

Small enough to sit on the palm of her hand, it gives her a result in "less than two minutes".

Having consulted with her GP and her consultant she bought one. Once a week she pricks her finger tip and places a drop of blood on a disposable strip, which is placed in the machine, and has a result in minutes.

"It has changed my whole life. I am no longer constrained by appointments for blood tests."

The machine is available from England, costing about €630. The testing strips cost about €4 each. This compares with about €20 for having the test done at a GP or hospital, plus the costs of lab tests.

While Feeney does not expect every warfarin patient should be given a Coagucheck machine on the general medical system, she does feel the strips should be available as part of the Drug Payment Scheme. They are available on the national health systems in Britain and Germany, and soon will be in Spain.

She has written to the Department of Health regarding the issue and Green Party TD Paul Gogarty tabled a question in the Dáil in April last year to the then Minister for Health, Micheál Martin, on self-testing for patients on anti-coagulation therapy.

Dr Martin Daly, chairman of the IMO's GP committee, was involved in a pilot project five years ago involving 11 GP practices in the west using the Coagucheck system. It showed "very clearly" the system was "safe and efficient", he says.

Describing the current "incoherent" system for monitoring patients as a dangerous "time bomb", he is adamant that the coagucheck machinery should be provided to every GP in the State.

Cardiac surgeon and Irish Times columnist Maurice Nelligan, who performed Feeney's mitral valve replacement in 1984, is also "absolutely one hundred percent in favour" of making the Coagucheck system available to every GP, and any patient deemed competent to self-test.

A spokesperson for the Department said the reply given to Gogarty in the Dáil - that experts were assessing whether self-testing for patients was "realistic" - remained the position.

Kitty Holland

Kitty Holland

Kitty Holland is Social Affairs Correspondent of The Irish Times