Friday, 21. of November 2014
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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. The first globally shared results from Dr. med. Angelika Bernardo showed that 83.1% of INR values (called Quick.value back then) performed by patients themselves during 1986 and 1992 were within the therapeutic range. The recommendations which came from Bad Berleburg at that time are still valid today. Looking at international scientific literature with regard to this topic - based on countless studies – indicates that it was not believed, what was initiated in Bad Berleburg, Germany. The sentence: “Additional big studies must confirm these results” appears constantly at the end of almost every study. In Germany, however, INR self-management developed further; even though there were and still are some questions on the conclusiveness of the evidence. “The mature and responsive anticoagulated patient does not exist”. After all – according to the opinion of well-known scientists – half of the anticoagulated patients would be able to perform self-management (Thomas Decker Christensen, Dan Med Bull 2011; T58(5): B4284). Taking numbers from Germany as the base, 20% of patients are testing their INR by themselves, but on a global basis only 0.05% do. Studies on INR self-management since the last 20 years cover the patient’s quality of life only limited. More important was first to determine how often INR values fall within the therapeutic range; is there an increased bleeding rate? Are there more thromboembolic events? Are the coagulation meters safe? Are patients able to dose themselves? Everything is always in comparison with professional testing. Nevertheless there are few studies which confirmed an improved quality of life. And this “Plus” in quality of life is what we experience ourselves daily.

Christian Schaefer (Oct. 2011)