Self-management an option for oral anticoagulation
Warfarin-treated patients can monitor their INR safely but are reluctant
to do so |
Self-management for oral anticoagulation is as effective as routine
care, if patients are appropriately trained, a study published online
at BMJ
Online First (PDF 100K) on 10 October suggests.
Point-of-care devices were used by 242 patients receiving warfarin to
measure their international normalised ratio twice a week. Patients then
used a simple chart to adjust their dose. The control group of 275 patients
received routine care in UK oral anticoagulation clinics. There was no
significant difference between the two groups in the proportion of time
spent within the therapeutic range, but self-managed patients with initial
poor control showed a greater improvement in control.
In the self-management group there was a 20 per cent improvement in INR
for those whose target was 3.5 (mainly those with mechanical heart valves)
and a 15 per cent improvement for those with a target of 2.5. For the
routine care patients, there was an improvement of 3–5 per cent
for the two groups.
However, demand from patients for self management was limited — a
quarter of
patients who accepted the invitation to self-manage did not complete
the training and a fifth of those who did complete training withdrew
prematurely — although the researchers believe their findings may
change this.
“Now that self-management for anticoagulation has been shown to
be as safe and effective as routine care, it would be valid to test whether
this reassurance alters patients’ (and health professionals’)
equipoise in considering whether to accept self management in this context,” they
conclude. |
The
Pharmaceutical Journal
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