Key result
Management strategies such as computer-assisted dosing algorithms, centralized care, and self-testing/self-dosing improve the time in the therapeutic target range for patients on vitamin K antagonists.
Management strategies including computer-assisted dosing, centralized anticoagulation clinics, and self-testing/self-dosing effectively improve time in therapeutic range for atrial fibrillation patients on vitamin K antagonists.
Supports consideration where VKAs remain in use; leaves open effects on clinical events.
Most patients with atrial fibrillation need anticoagulant treatment with vitamin K antagonists for prevention of thromboembolism, in particular ischemic stroke. Many studies show the efficacy of this treatment but also that it is difficult to keep patients who use vitamin K antagonists in the proper treatment range. Both a too low and a too high intensity of anticoagulation significantly increase the risk of adverse events. Hence repeated monitoring of the intensity of anticoagulation and dose adjustments are required. Management strategies that improve the time in the therapeutic target range are computer-assisted dosing algorithms and centralized care in anticoagulation clinics. In addition, self-testing of the international normalized ratio and self-dosing of vitamin K antagonists has been introduced over the past 20 years and has been shown to be an effective and safe treatment modality.
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Levi et al. (2009) conducted a review in Atrial Fibrillation. Management strategies (computer-assisted dosing, centralized care, self-testing, and self-dosing) was evaluated. Management strategies such as computer-assisted dosing algorithms, centralized care, and self-testing/self-dosing improve the time in the therapeutic target range for patients on vitamin K antagonists.
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