What question did this study set out to answer?

To evaluate the clinical effectiveness and safety of patient self-management compared with routine clinical care in individuals receiving long-term oral anticoagulation therapy.

October 10, 2005BMJOpen Access

Self management of oral anticoagulation: randomised trial

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Why the study?

Does self-management of oral anticoagulation improve the percentage of time spent within the therapeutic range in patients receiving long-term warfarin?

Population

617 patients aged over 18 receiving long-term warfarin

Comparison

Self-management using a point of care device to… vs Routine care

Design

RCT, randomised, open

Follow-up

12 months

Authors

DFD A FitzmauriceUniversity of Limerick EMEmily MurrayUniversity of Essex DMDeborah McCahonAt Bristol

Discussion

Member takes

Implication

Self-management achieves similar TTR and safety to routine care; confirms feasibility as an alternative without overall superiority in unselected patients.

Key Points

To evaluate the clinical effectiveness and safety of patient self-management compared with routine clinical care in individuals receiving long-term oral anticoagulation therapy.
Multicentre open randomised controlled trial conducted in the UK involving 617 adults receiving warfarin, assigned to self-management (n = 337) or routine care (ISRCTN 19313375).
Intervention participants measured their international normalised ratio twice weekly using a point-of-care device and adjusted their warfarin doses using a dosing chart over a 12-month follow-up period.
Time spent within the therapeutic range showed no significant difference between self-management (70%) and routine care (68%), though self-managed patients with poor pre-study control experienced improved time in range.
Serious adverse event rates were 2.8 per 100 patient-years (9 patients) in the self-management group compared with 2.7 per 100 patient-years (7 patients) in the routine care group (chi-square = 0.02, P = 0.89).

Structured PICO

Does self-management of oral anticoagulation improve the percentage of time spent within the therapeutic range in patients receiving long-term warfarin?

Population

617 patients aged over 18 receiving long-term warfarin

Intervention

Self-management using a point of care device to measure international normalised ratio (INR) twice a week and a simple dosing chart to interpret warfarin dose over 12 months

Comparator

Routine care

Outcome

Percentage of time spent within the therapeutic range of international normalised ratiosurrogate

Self-management of oral anticoagulation is safe and achieves similar time in therapeutic range compared to routine care, with potential benefits for patients with initially poor control.

Cite This Study

Fitzmaurice et al. (2005) studied this question.

synapsesocial.com/papers/6a70b7655d37378ac1ddd9d2 https://doi.org/10.1136/bmj.38618.580903.ae

Topics

Anticoagulation in AF

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Implication

Self-management achieves similar TTR and safety to routine care; confirms feasibility as an alternative without overall superiority in unselected patients.

Self management of oral anticoagulation: randomised trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Self management of oral anticoagulation: randomised trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider