Patient, Heal Thyself: The Ongoing Evolution of Patient Self-directed Care and Hand-Held Technology

Editorials5 April 2011Patient, Heal Thyself: The Ongoing Evolution of Patient Self-directed Care and Hand-Held TechnologyPaul Anaya, MD, PhD and David J. Moliterno, MDPaul Anaya, MD, PhDFrom The Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, 40536-0200. and David J. Moliterno, MDFrom The Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, 40536-0200.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-7-201104050-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Medical conditions that require long-term anticoagulation with warfarin are prevalent in the United States and worldwide. In the United States, atrial fibrillation affects approximately 1% of the population and is the primary condition for which long-term anticoagulation is given. Other conditions requiring long-term anticoagulation, such as venous thromboembolism and mechanical prosthetic heart valves, are also common (1, 2). Although treatment with warfarin has been shown to reduce the incidence of stroke and mortality, 20% to 30% of patients who receive warfarin therapy are inadequately treated (3, 4). This is because warfarin has a narrow therapeutic window; is associated with numerous ...References1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370-5. [PMID: 11343485] CrossrefMedlineGoogle Scholar2. Deitelzweig SB, Johnson BH, Lin J, Schulman KL. Prevalence of clinical venous thromboembolism in the USA: Current trends and future projections. Am J Hematol. 2011;86:217-20. [PMID: 21264912] CrossrefMedlineGoogle Scholar3. Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med. 1999;131:492-501. [PMID: 10507957] LinkGoogle Scholar4. Waldo AL, Becker RC, Tapson VF, Colgan KJ; NABOR Steering Committee. Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation. J Am Coll Cardiol. 2005;46:1729-36. [PMID: 16256877] CrossrefMedlineGoogle Scholar5. Ferder NS, Eby CS, Deych E, Harris JK, Ridker PM, Milligan PE, et al. Ability of VKORC1 and CYP2C9 to predict therapeutic warfarin dose during the initial weeks of therapy. J Thromb Haemost. 2010;8:95-100. [PMID: 19874474] CrossrefMedlineGoogle Scholar6. Caldwell MD, Awad T, Johnson JA, Gage BF, Falkowski M, Gardina P, et al. CYP4F2 genetic variant alters required warfarin dose. Blood. 2008;111:4106-12. [PMID: 18250228] CrossrefMedlineGoogle Scholar7. Bloomfield HE, Krause A, Greer N, Taylor BC, MacDonald R, Rutks I, et al. Meta-analysis: effect of patient self-testing and self-management of long-term anticoagulation on major clinical outcomes. Ann Intern Med. 2011;154:472-82. LinkGoogle Scholar8. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet. 2006;367:404-11. [PMID: 16458764] CrossrefMedlineGoogle Scholar9. Garcia-Alamino JM, Ward AM, Alonso-Coello P, Perera R, Bankhead C, Fitzmaurice D, et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev. 2010;:CD003839. [PMID: 20393937] MedlineGoogle Scholar10. Matchar DB, Jacobson A, Dolor R, Edson R, Uyeda L, Phibbs CS, et al; THINRS Executive Committee and Site Investigators. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363:1608-20. [PMID: 20961244] CrossrefMedlineGoogle Scholar11. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51. [PMID: 19717844] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Paul Anaya, MD, PhD; David J. Moliterno, MDAffiliations: From The Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, 40536-0200.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0382.Corresponding Author: David J. Moliterno, MD, Division of Cardiovascular Medicine, University of Kentucky, 900 South Limestone Avenue, 317 Wethington Building, Lexington, KY 40536-0200; e-mail, moliterno@uky.edu.Current Author Addresses: Drs. Anaya and Moliterno: Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, 900 South Limestone Avenue, 317 Wethington Building, Lexington, KY 40536-0200. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-analysis: Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes Hanna E. Bloomfield , Ange Krause , Nancy Greer , Brent C. Taylor , Roderick MacDonald , Indulis Rutks , Preetham Reddy , and Timothy J. Wilt Metrics Cited byPatient Self-Management of Oral Anticoagulation with Vitamin K Antagonists in Everyday Practice: Efficacy and Safety in a Nationwide Long-Term Prospective Cohort StudyAntithrombotic Therapy in Patients With Atrial Fibrillation Undergoing Coronary StentingConsensus Document: Antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting 5 April 2011Volume 154, Issue 7Page: 500-501KeywordsAnticoagulantsDrugsHealth careHeartHemorrhageInternational normalized ratioMortalityQuality of lifeStrokeVenous thromboembolism ePublished: 5 April 2011 Issue Published: 5 April 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...