We motivate patients to take control of their own oral anticoagulation therapy
More than 4.000.000 patients in Europe are living on long-term oral anticoagulation.
The target of the International Self-Monitoring Association of oral Anticoagulated Patients (ISMAAP) is to offer patients a better understanding what coagulation means.
How to live with anticoagulants. What kind of risks exists and also the benefit for anticoagulated patients.
On the other hand we are looking for a better cooperation between patients and physicians.
Physicians should understand the problems and worries of the patients when patients have to on long-time anticoagulation. Here we need a better way of communication.
In the name of the authors, we would like to thank you for taking interest in these subjects. Managing Board of the ISMAAP, Geneva.
"Active, informed patients are natural partner in managing anticoagulation therapy efficiently"
Anticoagulation - Patient Self-Management
A plus in quality of life since 25 years
A plus in quality of life happened for Heike Sichmann, the pioneer in INR self-management, in 1986. It was and is the independence of continuous INR tests at the doctor’s office. This “Plus” was successfully implemented by Dr. med Carola Halhuber and Dr. med. Angelika Bernardo by taking up the concept of coagulation self-management. The first patient trainings were conducted in Bad Berleburg, patient seminars – exemplary at that time – explained the handling of anticoagulants, patient advisors and scientific studies followed.
Is INR self-testing a good thing?
Alan Jacobson, MD, Loma Linda, Ca, USA in interview. (We have published the movie on youtube)
Living with anticoagulants
We invite you to a journey between Scylla and Charybdis (please click on the picture below).
Atrial fibrillation: What happens actually?
Self-monitoring of blood-thinning treatment almost halves risk of developing blood clots compared with conventional care (The Lancet)
The therapeutic range for VKA is narrow and therefore requires regular monitoring and dose adjustment to prevent excessive anticoagulation that can result in major bleeding, or inadequate anticoagulation that can expose patients to the potentially fatal blood clots they are used to prevent.
Self-monitoring can improve the quality of anticoagulation and be more convenient for patients. Yet, the use of self-testing (patients test, but dosage is done by physicians) and self-management (patients test and adjust their own doses) has remained inconsistent both in and between countries, ranging from 20% of patients on anticoagulant therapy in Germany to just 1% of patients in the USA.
To provide more evidence of the benefit of self-monitoring, a team led by Carl Heneghan from the University of Oxford, Oxford, UK, pooled individual patient data from 11 randomised trials comparing self-monitoring of oral anticoagulation with conventional care.
They estimated the effect of self-monitoring on time to death, first major bleeding event, first thromboembolic event, and in important subgroups of patients such as the elderly and those with atrial fibrillation (a common and strong risk factor for stroke) and those with a mechanical heart valve.
Overall, self-monitoring reduced the risk of thromboembolic events by 49% compared with usual care. However, the rate of bleeding complications was similar in both groups and self-monitoring did not have a major effect on mortality.
The authors conclude: “Self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up.”
Heneghan C et al (Dec. 1, 2011)
New: Reimbursement in Switzerland
Since July 1st, 2011 reimbursement for test strips and monitoring monitor (CoaguChek) in Switzerland. More information: www.coagulationcare.ch
Atrial fibrillation still not treated adequately
During the “Asia-Pacific Cardiology Forum” along the World Congress of Cardiology on June 18, 2010, Prof. Marcel Levi, MD, PhD, informed journalists at a round table discussion that the prevalence and incidence atrial fibrillation will significantly increase due to the ageing population. In Europe alone, it is estimated that more than 4 million people suffer from atrial fibrillation. Main complication of atrial fibrillation is stroke. On one hand, so M. Levi, stroke is a high burden on families, on the other hand, strokes cause significant costs to health care system globally.
Survey about life with anticoagulants (anticoagulation monitoring survey [GLAS]) report on german speaking participants
C. Schaefer (ISMAAP, Geneva), E. Knight (AnticoagulationEurope, Bromley/UK), A. Bernardo, MD, Gais/ Switzerland. Evaluation done by Oxford University, Oxford/ UK
Recruitment took place over a period of 2 months (Sept.-Oct. 2009). Participants were recruited from advertisement placed on the German-speaking national sites of the International Self-Monitoring Association of Oral Anticoagulated Patients (ISMAAP, Geneva) website. Those who were interested were directed to a hyper link, which enabled them to access the survey questionnaire. The survey could then be completed on-line.
Lack of patient education – lack of compliance
“For every long-term treatment patient compliance is of the essence. It has been proven that compliance is improved, if patients are educated about the risk and benefits of the respective treatment“, so Prof. Dr. W. Wuillemin (Schweiz. Med. Forum No. 17 v. 25th April, 2001).
How is the situation regarding patient education? Is the current practice sufficient to achieve compliance in life-long treatment?
Efficacy and safety of very low-dose self-management of oral anticoagulation in patients with mechanical heart vale replacement (H. Koertke et al)
Background: Self-management improves oral anticoagulation control. Here we provide data of a preplanned interim analysis of very low-dose early self-controlled anticoagulation.
Methods: In a prospective, randomized, multicenter trial, 1,137 patients performed low-dose international normalized ratio (INR) self-management with a target INR range of 1.8 to 2.8 for aortic valve replacement recipients and 2.5 to 3.5 for mitral or double valve replacement recipients for the first six postoperative months. Thereafter, 379 patients continued to achieve the aforementioned INR target range (LOW group), whereas the INR target value was set at 2.0 (range, 1.6 to 2.1) for the remaining patients with aortic valve replacement and 2.3 (range 2.0 to 2.5) for the remaining patients with mitral valve or double valve replacement. One half of this latter group had to check their INR values once a week (VL1 group) the other half twice a week (VL2 group). Patients were followed up to 24 months.
Results: Beyond study month six, the incidence of thromboembolic events that required hospital admission was 0.58%, 0.0%, and 0.58% in the LOW, VL1 and VL2 groups, respectively (p= 0.368). The incidence of bleeding events per patient-year was 1.16%, 1.07%, and 0.58% in the LOW, VL1, and VL2 groups, respectively (p = 0.665). Mortality rate did not differ among study groups.
Conclusions: Data demonstrate the efficacy and safety of very low-dose INR self-management.
(Ann Thorac Surg 2010;90:1487-94)
Nov. 21th, 2010
Frequent monitoring of Atrial Fibrillation patients key to optimal outcomes when treated with anticoagulants
Latest opinion confirms overwhelming evidence of the benefits of risk-adjusted
oral anticoagulation on stroke reduction in patients with atrial fibrillation
The bigger picture
Millions of patients globally are treated with oral anticoagulants. Challenges associated with this treatment are dose finding and the INR monitoring, so Prof. Sogkwan Silaruks, Thailand on the “Asia Pacific Cardiology Forum” on June 15, 2010 in Beijing.
Self-monitoring and self-management of oral anticoagulation
The introduction of portable monitors (point-of-care devices) for the management of patients on oral anticoagulation allows self-testing by the patient at home. Patients who self-test can either adjust their medication according to a pre-determined dose-INR schedule (self-management) or they can call a clinic to be told the appropriate dose adjustment (self-monitoring). Several trials of self-monitoring of oral anticoagulant therapy suggest this may be equal to or better than standard monitoring.
Josep M Garcia-Alamino, Alison M Ward, Pablo Alonso-Coello, Rafael Perera, Clare Bankhead, David Fitzmaurice, Carl J Heneghan (2010)
Read more:
http://www.cochranejournalclub.com/self-monitoring-and-self-management-oral-anticoagulation-clinical/
Will Genetic Testing help?
For patients taking warfarin (Coumadin®) the only Vitamin K antagonist (VKAs) available in the US, keeping within ones INR range lessens the chance of an adverse reaction (bleeding) and increases the VKAs prevention of dangerous blood clots.
Sometimes technology can really change your life for the better.
Self-testing my INR on my portable monitor is one of those technologies. In 1992 I was in heart failure because my mitral valve fell apart (Myxomatous degeneration). I was short of breadth, couldn't walk and had to rest after speaking a few words. My valve was replaced with a St. Jude Valve on February 8th, 1993. I was back at work in 4 months at Columbia University in New York as a physician at the student health service. I am on lifetime warfarin to prevent blood clots in my reengineered heart. I was thrilled to be alive but dependant on monthly lab visits and having to hustle to find labs when we traveled.
Recently I decided to put together a video showing me doing my weekly INR test. I'm sure this is familiar to the many ISMAAP patients and visitors to the website. Here is a link to our YouTube video "Coumadin (the brand name of warfarin) Self-Testing Monitor". It is in real time and is 3:36 minutes long: http://www.youtube.com/watch?v=mT2bc9Q_wDc
Michael, Feb. 4th, 2010
Home monitoring of INR using point-of-care testing is a viable option for patient involvement.
In 1998 I read about INR monitors to help me regulate my warfarin dose. Warfarin (Coumadin) is the only vitamin K antagonist (VKA) available in the US. I attempted to obtain one through my health insurance company. It took two years and many letters from my Cardiologist to get my first monitor. Since that time most US insurance plans have reviewed the research data and have agreed to reimburse the cost of Monitors and supplies (test strips etc.). In March 2008 the largest Health Insurer (Medicare) began covering Monitors. As of April 2010 there are approximately 65,000 Americans who do self testing of the approximately 4 million Americans who take warfarin (1.6%). This is up from an estimated 50,000 in April of 2009. In some European Countries 25-50% of suitable patients on warfarin do self testing and self management. In the US our health care system pits hospitals that want to fill beds against insurers that want to minimize reimbursement. In most European Countries health care providers and insurers are one and the same therefore reducing hospital admissions benefits and controls costs. Also in the US Insurance Companies pay health care clinicians very little to review weekly results for those patients who self-test. It is advantageous for providers to have patients come in for monthly INR testing.
Patients with artificial heart valves:
Less “out-of-range” INR values under low dose
Background
INR self-management after mechanical heart valve replacement resulted in a higher compliance of therapy. INR self-management with low dose anticoagulation reduces the risk for thromboembolic events without increasing the risk of bleeding. The aim of the present study is to investigate the effects of a very low target range of INR value and to predefine a target value with more reduced complication rates.
News on anticoagulation management
From October 1-3, 2009, the 5th International Patient & Physician Conference on Anticoagulant Therapy took place in Brussels, Belgium. The event was organized by the International Self-Monitoring Association for oral Anticoagulated Patients (ISMAAP) and the International Self-Monitoring Association for oral Anticoagulation (ISMAA). On Friday October 2, the plenary lectures, which brought together medical experts and patient organizations, cast new light on some of the hot topics of life with anticoagulation therapy.
Anticoagulation therapy in the elderly patient
Rebecca J. Beyth, MD, MSc, Associate Professor, University of Florida at Gainesville
INR self-management in the elderly
Scott S. Kaatz, DO, MSc, FACP, Clinical Associate Professor of Medicine, Director Anticoagulation Clinics, Henry Ford Hospital, Detroit
Pregnancy under anticoagulation therapy – a high risk?
Hannelore Rott, MD, MVZ-Lab, Duisburg, Germany
Pregnancy under anticoagulation therapy – a high risk? (II)
Heinrich Koertke, MD, Bad Oeynhausen,Germany
Anticoagulation management modalities and quality of life
Scott S. Kaatz, DO, MSc, FACP, Clinical Associate Professor of Medicine, Director Anticoagulation Clinics, Henry Ford Hospital, Detroit
Dialogue between physicians and patients
Albert O. Meyer, Berne, Switzerland
and Hermann Kruettner, MD, Grossgmein, Austria
Travel in patients on anticoagulation
Heinz Voeller, MD, of Rüdersdorf, Germany
Perioperative management of anticoagulation
Jack Ansell, MD, Chairman Department of Medicine, Lenox Hill Hospital, New York
Emergency reversal of anticoagulant therapy
Marcel Levi, MD, Academic Medical Center, University of Amsterdam, the Netherlands
Self-monitoring in real-life practice
Chris Gardiner, PhD, Department of Haematology, University College London Hospitals, London, United Kingdom
What will the future of anticoagulation look like?
David Garcia, MD, Albuquerque, USA
Photo: Chairpersons of 10 European national organizations.
ISMAAP 2009 - Convegno a Bruxelles
INR Self-Management – A model for the future
The 10th National Conference on Anticoagulation Therapy was held May 7th – 9th 2009 in San Diego, USA. I attended as the representative from the International Self Monitoring Association of Anticoagulated Patients (ISMAAP).
During the conference, it was discussed with more than 700 participants, whether INR self management is a beneficial approach. Lynn Oertel, Boston, raised the question, whether INR self management is really a new approach and referred to Germany, where 20% (160,000) of patients on anticoagulation therapy perform INR self management. In contrast, only 1% of US patients perform INR tests at home, no one even to talks about self- management.
Menorrhagia is common in patients on oral anticoagulation with vitamin-k-antagonist phenprocoumon
Objectives: To assess the menstrual blood flow of 46 women on long term oral anticoagulation (OAC) with phenprocoumon in comparison to normal values from the literature.
Reimbursement in Europe
In some countries, doctors generally or the thrombosis service agree that patients should manage the self-monitoring of long-term oral anticoagulation on their own and take control of their anticoagulation therapy. In these countries, reimbursement of the necessary equipment for self-monitoring is usually granted by the national health insurance authority.
However, in other countries, self-monitoring of long-term oral anticoagulation can be carried out only in very close cooperation with the general practitioner and/or the lab. In these countries, reimbursement by the national health insurance authority of the necessary equipment is for self-monitoring not yet possible.
Education, Training, and Self-Management not only for Seniors
Patient education and training is a substantial part being anticoagulated in order to know how to deal properly with Oral Anticoagulants.
Misconceptions that alarm anticoagulated patients
We check everyday that many anticoagulated patients are overwhelmed and scared by warnings and prohibitions, usually absurd and unfounded, from relatives or friends, and even sometimes from the medical staff. We refer to drugs and food that anticoagulated patients are or not able to have.
Embolism and Thrombosis
As a member of the Health Group FEASAN, I considered it to be advisable to write this short article on thrombosis and embolism in order to clarify some concepts that might help us to understand appropriately their right meaning. This description is due to the fact that, on many occasions, both terms are mentioned indistinctly, missing their exact differences, either etiological, structural or clinic ones.
Remboursement pour les enfants
Prise en charge du CoaguChek®XS ou de l’INRatio® pour les enfants.
Les enfants, de moins de 18 ans, sous AVK au long court pourront à partir du 7 Juillet 2008, bénéficier d’une prise en charge totale des autotests de l’INR (CoaguChek® XS, INRatio®) et de leurs bandelettes (en boite de 12 pour l’ INRatio® et en boite de 24 pour le CoaguChek® XS).
Les arrêtés ont été publiés ce matin au Journal Officiel de la République Française ( N° 0146 du 24 Juin 2008).
Safety for anticoagulated patients in Spain
Control of anticoagulation is carried out daily to near one hundred thousand patients at Spanish Hospitals and Health Centres. The Spanish Anticoagulated Patients Associations need to question whether such controls are carried out correctly at those Hospitals and Health Centres.
Last modification: January 3rd, 2012
Please note this website should not be used to replace advice from your doctor.