Self-management of anticoagulation

Abstract

Treatment with vitamin K antagonists (i.e., warfarin or coumadin derivatives) requires repeated monitoring of the intensity of anticoagulation and regular dose adjustment. Nevertheless, many patients are not in the therapeutic target range for a considerable proportion (30–50%) of the time. In addition, repeated laboratory checks and visits to the (anticoagulation) clinic or office are time-consuming and may have a negative impact on patient satisfaction. Recently, reliable portable coagulometers have become available and these devices allow the measurement of the international normalized ratio (INR) from a small drop of capillary blood, thereby enabling patients to self-manage their anticoagulation. Clinical studies show that self-testing of the INR and self-adjusting of the warfarin dose results in a better control of anticoagulation in comparison with regular care by general practitioners or specialists and is at least as good as management by a specialized anticoagulation clinic. Moreover, treatment-related patient satisfaction and quality of life improves in patients performing self-management of anticoagulation.

Keywords::

• anticoagulant
• self-management
• vitamin K antagonist

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.