Advertisement

Clinical Outcome of Self-Management of Oral Anticoagulation in Patients with Atrial Fibrillation or Deep Vein Thrombosis

      The indications for oral anticoagulation with coumarin derivatives have grown considerably and have received increasing confirmation following the many discoveries made in recent years. In principle, oral anticoagulation therapy can be monitored through measurement of the prothrombin time (PT) by four different methods: routine medical care by the treating general practitioner or specialist; anticoagulation clinics; self-testing (the patient performs the PT, but the physician adjusts the coumarin dosage); and self-management of oral anticoagulation by the patient himself [
      • Ansell J.E.
      • Hughes R.
      Evolving models of warfarin management anticoagulation clinics, patient self-monitoring, and patient self-management.
      ]. This method allows the patient to determine PT himself in a capillary blood sample using a coagulation monitor and to make any necessary adjustments to his dosage of oral anticoagulant. Prerequisites for self-management are reliable coagulation monitors and a standardized and structured patient training program that covers both theoretical and practical aspects of oral anticoagulation [

      Arbeitsgemeinschaft Selbstkontrolle der Antikoagulation: Standards und Informationen. In: Bernardo A, Taborski U, Wittstamm FJ, editors. Bad Nauheim: Eigenverlag; 4. Aufl. 1996.

      ,
      • Sawicki P.T.
      A structured teaching and self-management program for patients receiving oral anticoagulation.
      ]. In Germany over 40,000 patients have been introduced since 1986 to self-management of oral anticoagulation. Prosthetic heart valves represent 45% of the major indications, a further 50% have atrial fibrillation or thrombophilia, and the remaining 5% have other indications for long-term anticoagulation [
      • Taborski U.
      • Müller-Berghaus G.
      State-of-the-art patient self-management for control of oral anticoagulation.
      ]. Since self-management was initially performed by patients with heart valve replacement, most of the previously published investigations dealt mainly with these patients [
      • Sawicki P.T.
      A structured teaching and self-management program for patients receiving oral anticoagulation.
      ,
      • Horstkotte D.
      • Piper C.
      • Wiemer W.
      • Schulte H.D.
      • Schultheiß H.P.
      Optimization of oral anticoagulation following valve replacement Results of prospective randomized studies.
      ,
      • Körfer R.
      • Körtke H.
      Escat Early self-controlled anticoagulation trial.
      ,
      • Bernardo A.
      Experience with patient self-management of oral anticoagulation.
      ,
      • Hasenkam J.M.
      • Kimose H.H.
      • Knudsen L.
      Self-management of oral anticoagulant therapy after heart valve replacement.
      ,
      • Ansell J.
      • Patel N.
      • Ostrovsky D.
      • Nozzolillo E.
      • Peterson A.M.
      • Fish L.
      Long-term patient self-management of oral anticoagulation.
      ,
      • Morsdorf S.
      • Erdlenbruch W.
      • Taborski U.
      • Schenk J.F.
      • Erdlenbruch K.
      • Novotny-Reichert G.
      • Krischek B.
      • Wenzel E.
      Training of patients for self-management of oral anticoagulant therapy Standards, patient suitability, and clinical aspects.
      ,
      • Hasenkam J.M.
      • Knudsen L.
      • Kimose H.H.
      • Grønnesby H.
      • Attermann J.
      • Andersen N.T.
      • Pilegaard H.K.
      Practicability of patient self-testing of oral anticoagulant therapy by the International Normalized Ratio (INR) using a portable whole blood monitor. A pilot investigation.
      ,
      • Kulinna W.
      • Ney D.
      • Wenzel T.
      • Heene D.L.
      • Harenberg J.
      The effect of self-monitoring in the INR on quality of anticoagulation and quality of life.
      ]. These studies showed that self-management leads to an improvement of both anticoagulation therapy [
      • Sawicki P.T.
      A structured teaching and self-management program for patients receiving oral anticoagulation.
      ,
      • Horstkotte D.
      • Piper C.
      • Wiemer W.
      • Schulte H.D.
      • Schultheiß H.P.
      Optimization of oral anticoagulation following valve replacement Results of prospective randomized studies.
      ,
      • Körfer R.
      • Körtke H.
      Escat Early self-controlled anticoagulation trial.
      ,
      • Bernardo A.
      Experience with patient self-management of oral anticoagulation.
      ,
      • Hasenkam J.M.
      • Kimose H.H.
      • Knudsen L.
      Self-management of oral anticoagulant therapy after heart valve replacement.
      ,
      • Ansell J.
      • Patel N.
      • Ostrovsky D.
      • Nozzolillo E.
      • Peterson A.M.
      • Fish L.
      Long-term patient self-management of oral anticoagulation.
      ,
      • Morsdorf S.
      • Erdlenbruch W.
      • Taborski U.
      • Schenk J.F.
      • Erdlenbruch K.
      • Novotny-Reichert G.
      • Krischek B.
      • Wenzel E.
      Training of patients for self-management of oral anticoagulant therapy Standards, patient suitability, and clinical aspects.
      ,
      • Hasenkam J.M.
      • Knudsen L.
      • Kimose H.H.
      • Grønnesby H.
      • Attermann J.
      • Andersen N.T.
      • Pilegaard H.K.
      Practicability of patient self-testing of oral anticoagulant therapy by the International Normalized Ratio (INR) using a portable whole blood monitor. A pilot investigation.
      ,
      • Kulinna W.
      • Ney D.
      • Wenzel T.
      • Heene D.L.
      • Harenberg J.
      The effect of self-monitoring in the INR on quality of anticoagulation and quality of life.
      ] and treatment-related quality of life [
      • Sawicki P.T.
      A structured teaching and self-management program for patients receiving oral anticoagulation.
      ,
      • Kulinna W.
      • Ney D.
      • Wenzel T.
      • Heene D.L.
      • Harenberg J.
      The effect of self-monitoring in the INR on quality of anticoagulation and quality of life.
      ]. However, little is known about the clinical outcome of patients with atrial fibrillation or deep vein thrombosis who perform self-management of oral anticoagulation therapy.

      Keywords

      Abbreviations:

      PT, prothrombin time (), INR, international normalized ratio ()
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Thrombosis Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ansell J.E.
        • Hughes R.
        Evolving models of warfarin management.
        Am Heart J. 1996; 132: 1095-1100
      1. Arbeitsgemeinschaft Selbstkontrolle der Antikoagulation: Standards und Informationen. In: Bernardo A, Taborski U, Wittstamm FJ, editors. Bad Nauheim: Eigenverlag; 4. Aufl. 1996.

        • Sawicki P.T.
        A structured teaching and self-management program for patients receiving oral anticoagulation.
        JAMA. 1999; 281: 145-150
        • Taborski U.
        • Müller-Berghaus G.
        State-of-the-art patient self-management for control of oral anticoagulation.
        Semin Thromb Hemostas. 1999; 25: 43-47
        • Horstkotte D.
        • Piper C.
        • Wiemer W.
        • Schulte H.D.
        • Schultheiß H.P.
        Optimization of oral anticoagulation following valve replacement.
        Ann Hematol. 1996; 72: A90
        • Körfer R.
        • Körtke H.
        Escat.
        in: Krian A. Matloff J.M. Nicoloff D.M. Advancing the Technology of Bileaflet Mechanical Heart Valves. Steinkopf-Verlag, Darmstadt, Germany1998: 12-22
        • Bernardo A.
        Experience with patient self-management of oral anticoagulation.
        J Thromb Thrombolysis. 1996; 2: 321-325
        • Hasenkam J.M.
        • Kimose H.H.
        • Knudsen L.
        Self-management of oral anticoagulant therapy after heart valve replacement.
        Eur J Cardiothorac Surg. 1997; 11: 935-942
        • Ansell J.
        • Patel N.
        • Ostrovsky D.
        • Nozzolillo E.
        • Peterson A.M.
        • Fish L.
        Long-term patient self-management of oral anticoagulation.
        Arch Intern Med. 1995; 155: 2185-2189
        • Morsdorf S.
        • Erdlenbruch W.
        • Taborski U.
        • Schenk J.F.
        • Erdlenbruch K.
        • Novotny-Reichert G.
        • Krischek B.
        • Wenzel E.
        Training of patients for self-management of oral anticoagulant therapy.
        Semin Thromb Hemostas. 1999; 25: 109-115
        • Hasenkam J.M.
        • Knudsen L.
        • Kimose H.H.
        • Grønnesby H.
        • Attermann J.
        • Andersen N.T.
        • Pilegaard H.K.
        Practicability of patient self-testing of oral anticoagulant therapy by the International Normalized Ratio (INR) using a portable whole blood monitor. A pilot investigation.
        Thromb Res. 1997; 85: 77-82
        • Kulinna W.
        • Ney D.
        • Wenzel T.
        • Heene D.L.
        • Harenberg J.
        The effect of self-monitoring in the INR on quality of anticoagulation and quality of life.
        Semin Thromb Hemostas. 1999; 25: 123-126
        • Kapiotis S.
        • Quehenberger P.
        • Speiser W.
        Evaluation of the new method CoaguChek for the determination of prothrombin time from capillary blood.
        Thromb Res. 1995; 77: 563-567
        • Van den Besselaar A.M.H.P.
        • Breddin K.
        • Lutze G.
        • Parker-Williams J.
        • Taborski U.
        • Vogel G.
        • Trischler W.
        • Zerback R.
        • Leinberger R.
        Multicenter evaluation of a new capillary blood prothrombin time monitoring system.
        Blood Coag Fibrinolysis. 1995; 6: 726-732
        • Ruzicka K.
        • Kapiotis S.
        • Quehenberger P.
        • Handler S.
        • Hornykewycz S.
        • Michitsch A.
        • Huber K.
        • Clemens D.
        • Susan M.
        • Pabinger I.
        • Eichinger S.
        • Jilma B.
        • Speiser W.
        Evaluation of bedside prothrombin time and activated partial thromboplastin time measurement by coagulation analyzer CoaguChek Plus® in various clinical settings.
        Thromb Res. 1997; 87: 431-440
        • Anderson D.
        • Harrison L.
        • Hirsh J.
        Evaluation of a portable prothrombin monitor for home use by patients who require long-term oral anticoagulant therapy.
        Arch Intern Med. 1993; 153: 1441-1447
        • Landefeld G.S.
        • Goldman L.
        Major bleeding in outpatients treated with warfarin.
        Am J Med. 1989; 87: 144-152