Wednesday, 26. of November 2014
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Self-monitoring in real-life practice

Chris Gardiner, PhD, Department of Haematology, University College London Hospitals, London, United Kingdom, described the design and the results of the study “Self monitoring of oral anticoagulation: Does it work outside trial conditions?” (Journal of Clinical Pathology, February 2008, Volume: 62 (2): 168-71. Less than 1% of the estimated one million patients receiving oral anticoagulation therapy (OAT) in the UK monitor their own PT/INR. Patient self-monitoring (PSM) of OAT is known to improve anticoagulant control, but poor uptake and high dropout rates in UK studies have prompted suggestions that PSM is suitable for only a minority of patients. In this study 318 consecutive patients referred, for the first time, to an anticoagulation clinic were assessed for eligibility using established criteria. Patients electing for PSM attended training and, following successful assessment, performed a capillary blood INR every two weeks or more frequently if directed to do so by the anticoagulation clinic. The aim was to determine whether PSM is a viable alternative to regular hospital anticoagulant clinic attendance, if offered to the patient from the start of treatment. “23% of all patients receiving oral anticoagulation were suitable, willing and able to self-test,” Gardiner said, summarizing the results. “The uptake is improved if offered at the start of treatment, particularly among younger patients.”Two more findings: Most patients were happy to remain on self-testing rather than proceeding to self-management, and the quality of anticoagulant control achieved through PST may be superior to that of the routine specialist anticoagulant clinic.“The situation in the UK is like this: Test strips are available on prescription from the National Health Service, but some general practitioners and primary care trusts are reluctant to prescribe strips, because they are still sceptical about self-monitoring,” said Gardiner. “They think that self-monitoring is suitable for only a minority of patients. But hospitals cannot cope with the increasing numbers of patients requiringanticoagulation.”

Report by Thomas Klein, MD, MSc (Nov. 2009)