Tuesday, 23. of September 2014
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Therapeutical range

You have a mechanical aortic heart valve:
What is your therapeutical range?


INR 1,6 - 2,1
INR 1,8 - 2,8
INR 2,5 - 3,5
INR 2,5 - 4,5

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We motivate patients to take control of their own oral anticoagulation therapy

More than 6.000.000 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"

Patient Self-Management

Diane tells us how it was to get an INR tester after nearly three decades on warfarin. "I've been freed from hours spent in clinics, taking time off work, having to consider appointments around work and family commitments. It's release - an escape from prison."

http://www.youtube.com/watch?v=Hu553aCUh7o

Patient Self-Management

Heike Sichmann is the very first wafarin patient to self-test. She has been taking warfarin for 20 years and testing herself. Learn why she feels safer taking warfarin and testing her INR at home. 

http://www.youtube.com/watch?v=poJ72aWfiPA

Patient Self-Management

Christian has had an artificial heart valve for more than 25 years and needs to take an anticoagulant regularly. Since 1987 he uses a self-monitoring device which allows him to control his coagulation levels himself. This breakthrough technological discovery has given him and countless other patients back a great deal of freedom and independence.

http://www.youtube.com/watch?v=zlehoGx5BBk

Patient Self-Management

INR testing can be done in the clinic as a laboratory or capillary test. Both require the patient to interrupt their normal life to travel to the clinic. Dr. Christoph Sucker talks about Patient Self-Testing, an alternative to clinic testing that results in increased TTR (Time in Therapeutic Range) and quality of life.

http://www.youtube.com/watch?v=JuZ2OuYKFrg

Nosebleed information for persons on anticoagulant medicines (ACM's)

Nosebleeds (epistaxis) are very common. Most nosebleeds occur because of minor irritations or colds. Some nosebleeds are caused by injury to the face or nose. Nosebleeds can be frightening for some patients, but are rarely life threatening. Persons taking ACM's (sometimes called blood-thinning medications) such as warfarin (also known under the brand names Coumadin®, Jantoven®, Marevan®, Lawarin®, Waran®, and Warfant®), apixaban(Eliquis®), dabigatran (Pradaxa® in Australia, Europe, USA and Canada, Prazaxa® in Japan), rivaroxaban (Xarelto®), clopidogrel bisulfate (Plavix®),  nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin have an additional concern. Is my medicine causing or contributing to my nosebleed?

read more...

Anticoagulation news No. 7, Sept 2012

Christian Schaefer, Ratingen, Germany: Anticoagulation and patient sooperation go hand in hand.

Christian Schaefer, Ratingen, Germany: Patient should take ovver INR self-management

Age limitation for INR self-testing?

Anticoagulation news No. 8, Oct. 2012

Torben Bjerregaard Larsen, MD, PhD, Alborg, Denmark: High anticoagulation management vs new anticoagulants. Why a high TTR is important.

Anders Själander, MD, Sundsvall, Sweden: Patient compliance, anticoagulants and TTR.

Anticoagulation news No. 9, Nov. 2012

Hugo ten Cate, MD, PhD, Maastricht, The Netherlands: Monitoring new oral anticoagulants, managing thrombosis, or both?

Philipp Wild, MD, Msc, Mainz, Germany: Evaluation of oral anticoagulation in a real-life setting – the multicenter thrombEVAL study program.

Anticoagulation news No. 10, Dec. 2012

Strategies for a better outcome of the TTR and an improved patient compliance:

The Danish way presented by Nini Leroul, Tina Ginnerup (www.AKpatient.dk) and Torben Bjerregard Larsen, MD.

The Austrian way presented by Ulrike Walchshofer (www.inr-austria.at ) and Benjamin Dieplinger, MD.

The French way presented by Antoîne Gobillard (www.avkcontrol.com) and Ludovic Drouet, MD

The Italian way presented by Nicola Merlin (www.aipapadova.com) andGentian Denas, MD.

The Spanish way presented by Luciano Arochena (www.anticoagulados.info) and Angeles Fernández, MD.

 

Anticoagulation News No. 11 - December 2012

The Swiss way presented by Andri Färber and Walter Wuillemin, MD. (www.inrswiss.ch)

The Dutch way presented by Cees N de Graaff and Ron van't Land, MD. (www.stizan.nl)

 

25 years Patient Self-Management

 

Alan Jacobson, MD, Loma Linda, USA, prescribed the interesting story of patient self-management.

Watch the video on youtube: http://www.youtube.com/watch?v=ecXKMM0bpOE

Anticoagulation and patient cooperation go hand in hand.

Telephone interviews were conducted last year in England by ACE (AnticoagulationEurope) and AFA (Atrial Fibrillation Association) with 104 patients with atrial fibrillation. The results, even with this small sample, represent the problems associated with the treatment of patients with atrial fibrillation. For 72% of patients the treatment with Vitamin-K-Antagonists started immediately; for 20% however, it started only after a longer period of time (up to one year). 

read more...

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. 

 read more...

Living with anticoagulants

We invite you to a journey between Scylla and Charybdis (please click on the picture below).

Atrial fibrillation: What happens actually?

http://www.youtube.com/watch?v=T0mhgU6JtJc

Is INR Self-testing a good thing?

Alan Jacobson, MD, Loma Linda, USA, in interview. (Watch the movie on youtube)

http://www.youtube.com/watch?v=jx0L0lacLKA

Patient should take over Self-Management

It has been more than 70 years since Karl Paul Link synthesized Coumarin in the USA. According to J. Ansell, MD, 1 – 2% of the population of developed countries today takes anticoagulants to protect themselves from arterial and venous thromboembolisms (Circulation. 2012; 125: 165-170). He continues: “The persistence of the drugs, even ones with many disadvantages such as Coumarins, states something about this compound.

read more...

Why it is so important to be in the therapeutic range

How well an INR is managed is represented by the time spent in the therapeutic range. In medical language this is called TTR (Time in Therapeutic Range). In other words: If my INR-values remain within the set therapeutic range for all or almost all of the time, the chances for bleeding or thromboembolism decrease. Prof. Alan Jacobson, (Loma Linda, California) clearly said, “Yes” to the importance of “TTR” at the 7th International Conference of ISMAAP in Lyon, France (4th to 5th November 2011).

read more...

 

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.

read more...

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.

read more...

 

Mangemement of longtime anticoagulation in a German patient population

 

The magazin "Die Gerinnung" (The Coagulation) started a reader survey (2003) in order to estimate the quality of the oral anticoagulation management. Altogehter 10.000 questionnaires could be evaluated (2004). In 2005 the poster was presented at the conference of the AnticoagulationForum in Orlando.

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?

more...

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

read more...

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.

more...

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.

read more...

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.

read more...

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.

read more...

 

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.

more...

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.

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.

more...

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.

more...

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.

more....

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.

...more

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.

more...

Spanish version...

The German magazine for anticoagulated patients

In German language:

"Die Gerinnung" No. 54

Was tun bei Verletzungen und wenn es blutet?

INR-Wert: Woher kommen die unterschiedlichen Ergebnisse zwischen Selbstmessung und Labor?

Umstellung von direkten oralen Antikoagulanzien (DOAK) auf Vitamin-K-Antagonisten

"Die Gerinnung" No. 53

Reisegwohnheiten antikoagulierter Patienten

Die Gerinnungsfaktoren und der therapeutische Bereich

Häufigkeit von INR-Kontrollen unter Medikation mit Kumarinderivaten

Ist Sport bei Vorhofflimmern möglich?

"Die Gerinnung" No. 52

"Dankbar für die eigene INR-Bestimmung"

Was tun bei Thrombosen und Embolien?

Jubiläum: 60 Jahre Marcumar® und 20 Jahre CoaguChek®

Der Umgang mit der INR-Dokumentation

"Die Gerinnung" No. 51

Eigenverantwortlichkeit und Lebensqualität

Operative Eingriffe unter Gerinnungshemmung

Wassertabletten (Diuretika) Wann, Welche, Warum?

Impfen unter Gerinnungshemmung

"Die Gerinnung" No. 50

Es blutet - wann zum Arzt?

Die Einnahme von blutfettsenkenden Medikamenten - Wer - Wann? Update 2013

Leser fragen ... Ärzte antworten: Dr. med. Hannelore Rott, PD Dr. med. Heinrich Körtke, PD Dr. med. Jan Steffel, DP Dr. med. Tomas Jelinek, Prof. Dr. med. Jürgen Ringwald, Dr. med. Andreas C. Bortsch.

"Die Gerinnung" No. 49

Mehr INR-Werte im therapeutischen Bereich - was ist zu verbessern?

Was bedeutet eigentlich Blutgerinnung und wie gehe ich damit um?

Wenn der INR-Wert aus dem Ruder läuft. 

"Die Gerinnung" No. 48

Gerinnungshemmung und Patientenmitarbeit gehören zusammen.

Was können wir von den neuen Gerinnungshemmern erwarten?

Aktuelle Studienlage zur Einnahme von blutfettsenkenden Medikamenten.

"Die Gerinnung" No. 47

Patienten sollte das Selbstmanagement übertragen werden.

Schmerzen unter Gerinnungshemmung mit Vitamin-K-Antagonisten - Was tun?

Gerinnungshemmung bei Vorhofflimmern.

"Die Gerinnung No. 46

Sexualität nach Herzinfarkt

Phenprocoumon und Plättchenfunktionshemmer

Was bedeutet Niereninsuffizienz für antikoagulierte Patienten?

Last modification

Last modification: Sept. 17th, 2014

Please note this website should not be used to replace advice from your doctor.