Marcel Levi, MD PhD, University of Amsterdam, the Netherlands:
"Self-management of anticoagulation has shown to reduce many burdens that are associated with patient perception of anticoagulant treatment. The ability to have more control over one’s own health and health management probably plays an important role. In addition, it is reassuring to see that more and more clinical studies on effectiveness of anticoagulant treatment are going to take into account the preference of the patient and the perception of the treatment by the patient. So more and more, we will have to shift from treating a disease with anticoagulants to improving a patient’s life with anticoagulants in a way that fits best."
Prof. Dr. med. F.R. Rosendaal, Leiden University, Leiden/ the Netherlands:
"Oral anticoagulation is effective in the prevention and treatment of thrombosis. The major drawback of therapy with vitamin K antagonists is the increased risk of haemorrhage. The precious balance between effect and side-effect can be optimised at several levels, e.g. in the monitoring laboratory, in the choice of target intensity, in the use of specific treatment and dosing strategies (such as computer-assisted dosing, or self-management) and by improving patients' compliance."
Hannelore Rott, MD, Specialist in Transfusion Medicine, Duisburg/Germany:
"In German patients on anticoagulation with vitamin-K-antagonists, prosthetic heart valves represent about 45 % of the major indications, a further of 50 % have thromboembolism/thrombophilia or atrial fibrillation, and the remaining other 5 % have other indications. Usually the management of anticoagulation is performed by a general practitioner, who sends the blood specimen of the patient to a private laboratory for measurement of INR.In Germany, anticoagulation self-management is established since about 1993. Since then about 150.000 patients receiving oral anticoagulant therapy have been trained in using a self-monitoring system and successfully perform self-testing for control of INR. Furthermore self-management of anticoagulation is much cheaper for the German health system (Euro 686,39/year in patients on self-management vs. Euro 1054,92 /year in conventionally controlled patients) due to reduction of hospitalization, surgery and rehabilitation in case of bleeding and thromboembolic complications."
Eve Knight, Director and Co-Founder of AntiCoagulation Europe (UK), Bromley, United Kingdom:
"I self-mange my anticoagulant therapy following a deep vein thrombosis and pulmonary embolism. I am totally involved in the whole process of testing and dosing and this allows me to keep my INR stable and within my therapeutic range for 98 % of the time. It also gives me the freedom to continue my work, and allows me to enjoy my holidays. Patients need access to good quality accurate information in order to support patient choice."
I: (from left to right) Marcel Levi, MD PhD; Christian Schaefer; Prof. Dr. F.R. Rosendaal and Eve Knight
II: ISMAAP stand on the ISTH (Nov. 20th, 2007)