Clinical Outcome of Self-Management of Oral Anticoagulation in Patients with Atrial Fibrillation or Deep Vein Thrombosis

Abstract

The indications for oral anticoagulation with coumarin derivatives have grown considerably and have received increasing confirmation following the many discoveries made in recent years. In principle, oral anticoagulation therapy can be monitored through measurement of the prothrombin time (PT) by four different methods: routine medical care by the treating general practitioner or specialist; anticoagulation clinics; self-testing (the patient performs the PT, but the physician adjusts the coumarin dosage); and self-management of oral anticoagulation by the patient himself [1]. This method allows the patient to determine PT himself in a capillary blood sample using a coagulation monitor and to make any necessary adjustments to his dosage of oral anticoagulant. Prerequisites for self-management are reliable coagulation monitors and a standardized and structured patient training program that covers both theoretical and practical aspects of oral anticoagulation [2,3]. In Germany over 40,000 patients have been introduced since 1986 to self-management of oral anticoagulation. Prosthetic heart valves represent 45% of the major indications, a further 50% have atrial fibrillation or thrombophilia, and the remaining 5% have other indications for long-term anticoagulation [4]. Since self-management was initially performed by patients with heart valve replacement, most of the previously published investigations dealt mainly with these patients [3,5–12]. These studies showed that self-management leads to an improvement of both anticoagulation therapy [3,5–12] and treatment-related quality of life [3,12]. However, little is known about the clinical outcome of patients with atrial fibrillation or deep vein thrombosis who perform self-management of oral anticoagulation therapy.