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  • Publication # 14-RA002

Stealth alerts improve rate of warfarin monitoring for patients starting an interacting medication

Patient Safety and Quality

A patient on warfarin is sometimes given another medication that could interact with the anticoagulant. When this happens, an alert that goes to an interdisciplinary anticoagulation management service is more effective than alerting the prescribing physician in ensuring anticoagulation monitoring is completed within 5 days of the new prescription, according to a new study. Such monitoring is important to ensure that warfarin stays within effective levels in the presence of the new medication. 

The researchers tested the stealth alert in a pre-intervention/post-intervention study. A total of 1,553 patients were seen in the pre-intervention period and 1,709 in the post-intervention period. Before the stealth alerting system was implemented, 34 percent of anticoagulant patients completed monitoring within 5 days of being prescribed a medication that had the potential to interact with warfarin. After the stealth alert intervention was introduced, 39 percent of the patients completed their monitoring within the 5-day goal, a significant increase of 24 percent. Significantly increased odds of completing monitoring were found at 3, 4, and 7 days (31 percent, 25 percent, and 27 percent, respectively). 

The researchers used data from the electronic health record of a large, multispecialty group practice. This study was funded in part by a grant from AHRQ (HS21094) to the Brigham and Women's Hospital Center for Education and Research on Therapeutics (CERT), which focuses on health information technology. For more information on the CERTs program, visit

More details are in "'Stealth' alerts to improve warfarin monitoring when initiating interacting medications," by Kate E. Koplan, M.D., M.P.H., Alan D. Brush, M.D., Marvin S. Packer, M.D., and others in the December 2012 Journal of General Internal Medicine 27(12), pp. 1666-1673.


Page last reviewed November 2013
Internet Citation: Stealth alerts improve rate of warfarin monitoring for patients starting an interacting medication: Patient Safety and Quality. November 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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