Quality of anticoagulation in self versus standard management: Assessing the influence of education level on self-managed patient outcomes

BACKGROUND: Self-management of vitamin K antagonist (VKA) therapy may enhance the quality of anticoagulation compared with conventional monitoring; however, selection criteria in low-socioeconomic settings-and the role of education-remain unclear. This study aims to evaluate the effect of education level and socio-economic factors on the quality of anticoagulation control. METHODS: This single-center observational study included adult patients on VKA for ≥6 months; exclusions were age >70 years, prior life-threatening bleeding/thromboembolism, illiteracy without a co-resident caregiver, or refusal to join the study. Participants followed self-management (1-h training and a dose-INR algorithm with escalation rules) or standard clinic monitoring led by specialized nurses. Follow-up was conducted for 6 months. Primary endpoints were Roosendaal TTR and percentage of INR tests in range. RESULTS: A total of 589 participants were enrolled (self-management n = 295; standard n = 294); 6-month TTR was available for 524 patients (255 vs 269; respectively). Median [Q1-Q3] TTR was similar between groups (63% [41-85] vs 59% [44-79]; p = 0.55), as was the percentage of INR tests in range (57% [36-78] vs 57% [42-71]; p = 0.76). Using tests-in-range categories, self-management had higher rates of both adequate control (>70%) (36.6% vs 27.1%; p = 0.024) and poor control (<30%) (18.1% vs 10.8%; p = 0.018). Within the self-management group, Rosendaal TTR did not differ by education level (70.2%, 62.4%, 65.2%, and 58.3% for illiterate/primary/secondary/higher education; p = 0.66). CONCLUSION: Self-management of INR is feasible in low-socioeconomic settings and is not predicted by education level; rather, it requires structured training, demonstrated competency, and an effective health-support system.