Self-management of anticoagulation is at least as effective as monitoring by specialised clinics, say Dutch researchers. In addition, they say that self-management may improve compliance and reduce the need for frequent visits to anticoagulation clinics.
In a cross-over study, Dr Manon Cromheecke (department of cardiopulmonary surgery) and colleagues at the University of Amsterdam found that patients could measure their INR adequately and were able to devise appropriate dosing schemes for warfarin. There was no significant difference in the control of anticoagulation between patients who measured their own INR levels and those who attended anticoagulation clinics. An INR of +/–0.5 from the target therapeutic value was achieved by 55 per cent of the self-management group and 49 per cent of the clinic group during the study period. Sixty per cent of the self-management group and 52 per cent of the clinic group spent more than 50 per cent of the time within the target therapeutic range. Serious under- or over-coagulation was seen in 3.5 per cent of the self-management group and 5.3 per cent of the clinic group.
In terms of patient satisfaction, self-management of anticoagulation fared better. Patients' scores for daily anxieties, distress and strain were significantly lower in the self-management group, leading the researchers to conclude that it is a "patient-friendly" approach.
Dr Cromheecke comments that adequate support remains necessary for patients who self-manage their anticoagulation and that clinics could play a major role in this area. However, self-management may still be a cost-effective approach, he says.
The randomised study of 50 patients on long-term oral anticoagulants compared self-management and clinic monitoring for three months each. Efficacy was assessed using blind measurements of INR every one to two weeks (Lancet 2000;356:97).