Self-management of oral anticoagulation using a CoaguChek monitor increased the time within therapeutic target range to 77% compared with 53% for conventional management.
Cohort (n=41)
Does self-management of oral anticoagulant therapy improve time in therapeutic range in patients after heart valve replacement?
Self-management of oral anticoagulation using a point-of-care monitor is feasible and improves time in therapeutic range compared to conventional management in patients with mechanical heart valves.
Absolute Event Rate: 77% vs 53%
OBJECTIVE: Patients with mechanical heart valves require lifelong oral anticoagulant treatment which entails frequent blood sampling and dosage adjustment. The purpose of this study was to investigate the feasibility of letting heart valve operated patients manage blood specimen analysis and dosage adjustment themselves. METHODS: A total of 21 patients were enrolled in the study and followed for at least 9 months postoperatively. Immediately after the heart valve operation they were trained in operating a CoaguChek international normal ratio (INR) monitor to analyze capillary whole blood samples. Subsequently training in dosage adjustment was accomplished and all patients were considered fully capable of self management after 30 weeks. In the training period, parallel laboratory INR measurements were made at 3-4 week intervals for reference. A control group of 20 patients was matched, respectively, to the study group. The INR target range was 2.0-3.0. RESULTS: Out of the 21 study patients 19 continued self management beyond 9 months. The median INR value obtained with the monitor was within therapeutic target range for all study patients and only 15 out of 20 control patients were within this range. The mean systematic deviation between laboratory and CoaguChek INR was 7.8% but each patient had a constant characteristic deviation from -11 to +21%. The study patients were within therapeutic target range 77% of the time compared with 53% for the control patients. CONCLUSIONS: Self management of oral anticoagulation is feasible for selected patients and constitutes a significant service improvement compared with conventional management. The CoaguChek monitor seems sufficiently accurate and reliable for self testing and the treatment quality is comparable or even better than conventional management. Assessment of the rate of bleeding and thrombo-embolic events shall be settled in studies comprising larger number of patients.
J. Michael Hasenkam (Thu,) conducted a cohort in Mechanical heart valve replacement requiring oral anticoagulation (n=41). Self-management of oral anticoagulant therapy using CoaguChek monitor vs. Conventional management was evaluated on Time within therapeutic target range (INR 2.0-3.0). Self-management of oral anticoagulation using a CoaguChek monitor increased the time within therapeutic target range to 77% compared with 53% for conventional management.