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Anticoagulation Self-Management – 22 years on

In her book "Das Leben mit der neuen Herzklappe" ["Life with the New Heart Valve"], first published in 1986, Dr. Carola Halhuber wrote that it is unfortunately not yet possible – although it would be highly desirable – for patients to carry out quick and simple tests to monitor PT/INR results at home by themselves. In 1986, Heike Sichmann, a student at the time, demonstrated at a doctor-patient seminar in the Cardiovascular Clinic in Bad Berleburg that she was able to monitor her INR results by herself. The idea was so attractive that Dr. Carola Halhuber decided to adopt it and began to offer patient training courses at her clinic. Patients who happened to be in Bad Berleburg for rehab after a heart-valve operation found themselves in the right place at the right time. There weren't that many heart-valve patients around, but those who were there learned how to monitor their own INR results. Even statutory health insurance providers were willing to pay for the coagulometers. In the second edition of her book, published in 1989, she noted the burden placed on patients as a result of having to extract blood from their veins with relative frequency for the rest of their lives and to experience fluctuating INR results despite all efforts to the contrary. She also noted that self-monitoring of INR results was a relatively new option about which health insurance providers and doctors needed to be fully and correctly informed.

First results
Shortly thereafter, initial assessments were carried out to determine the effectiveness of INR self-monitoring and whether these results lay within the required therapeutic range. Dr. Angelika Bernardo of Gais, Switzerland evaluated the records of the first 300 INR self-monitors. The results showed that their results adhered better to the prescribed therapeutic range than monitoring by their doctors did. This marked the beginning of what was to become a major success story although more than ten more years were to pass before doctors, whether at home or abroad, were to focus attention on anti-coagulation self-management.


10 years later

Scientific publications on the subject started to appear in 1995. But it was not until the end of the 1990s that the results of major studies were published showing that patients on oral anti-coagulation therapy are perfectly able to master anti-coagulation self-management.

22 years later
Today there are more than 150,000 patients in Germany (worldwide 250,000) who monitor their INR values and dose theirs anticoagulants on their own at home at an average of about once a week. This is exceptional. Who hinders anticoagulated patients worldwide from self-monitoring?

Diabetics taking insulin have their own devices to assess their blood sugar and use them to good effect. So why not those who are on anticoagulants?

 

Christian Schaefer, Ratingen, Germany
anticoagulation news 2008;5:16

 

 

 

Breakthrough after the arrival of CoaguChek

German company, Boehringer Mannheim (now Roche Diagnostics) launched CoaguChek in 1994. This monitor made it much easier to determine INR. Whereas the KC1A monitor required half an hour and more, using CoaguChek meant that INR reading times could be reduced to just a few minutes. Latest versions of the CoaguChek (CoaguChek XS) monitor (compact, easy-to-use and requiring only a minute drop of blood) afford more dependability and even greater freedom.