|Sawicki PT et al.|
Long-Term Results of Patient's Self-Management of Oral Anticoagulation
Journal of Clinical and Basic Cardiology 2003; 6 (1-4): 59-62
Keywords: Antikoagulation, Kardiologie, Lebensqualität, Thromboembolie, Anticoagulation, cardiology, quality of life, Self-Management, thromboembolism
Objective: Control of oral anticoagulation therapy has been reported to be often inadequate. Prospective controlled randomised short-term investigations suggest that patients' self-management of oral anticoagulation may lead to improved control. Prospective long-term studies of this intervention are not available. Design: Prospective, multicenter, follow-up study of a randomised interventional trial. Setting and subjects: A structured teaching and treatment programme for self-management of oral anticoagulation was offered to 178 patients. Follow-up was until death or for a period of five years resulting in 809 patient years (py). Main outcome measures: Accuracy of anticoagulation control, measures of treatment-related quality of life, bleeding and thromboembolic complications. Results: 134 Patients (89 %) of the 150 patients, available for the final 5-years examination performed self-monitoring, 116 (77 %) performed self-adaptation of coumarin dosage. At baseline 32 % of patients were within the INR target range; during the final year of the follow-up period, 62 % of INR self-measurements were within the target range. On self-monitoring the mean squared deviation from the mean of the individual INR target range was 0.44 (standard deviation [SD] in parantheses) (0.77). The mean time within the target range was 225 days per year (d/y) and 80 d/y below and 60 d/y above the target range. During the follow-up period, 5 major bleeding complications (0.62 per 100 py) and 9 thromboembolic events (1.1 per 100 py) occurred. When compared to baseline, parameters of quality of life improved. Conclusions: We conclude that after participation in a structured teaching and treatment programme, compliance with self-management of oral anticoagulation persists in the long-term, results in an improvement of accuracy of anticoagulation control and quality of life and is associated with a relatively low risk of bleeding and thromboembolism.