30 years INR Patient Self-Management

Already in 1986: The target was >75% INR-values in therapeutical range!

1986 until 2016 – Better TTR is better

Enabling Patient Self-Management:

"It makes sense to give the anti-coagulated patients more responsibility and to transfer to them the responsibility of coagulation self-management."
Schaefer, C, Hospitalhealthcare

1986-1992: Patient Self-Management of Oral Anticoagulation (Germany)

"During the period from August 1986 to February 1992, 600 patients requiring long-term anticoagulation, mainly after heart valve replacement, were trained to measure their own PT at the Cardiac Rehabilitation Center (Herz-Kreislauf-Klinik, Bad Berleburg, Germany) and to manage their own therapy: 216 patients could be followed with regard to their self-determined prothrombin times. The results were within the target range in 83.1% of the PT determinations (n=12,306 measurements) taken by the patients themselves. Neither major bleeding nor thromboembolic complications were observed in 205 patient-years of self-monitoring of PT and self-management of oral anticoagulation."
Bernardo, A. J Thromb Thrombol (1996) 2: 321. doi:10.1007/BF01061920

2011: Anticoagulation control in Sweden (AuriculA)

"This, the first report from the Swedish national quality registry for anticoagulation and atrial fibrillation, AuriculA, shows that the quality of anticoagulation treatment given in the participating centres in Sweden is high. In this paper, we report a mean TTR of 76.2% in a large, unselected clinical population. If we expand the treatment range of INR to 1.8–3.2 for the coefficient of variation of the laboratory method of INR measurement as done in SPORTIF III, the mean TTR is increased to 88.4%."
Matthias Wieloch et al: htpp://dx.doi.org/10.1093/euroheartj/ehr134 2282-2289

2015: Cohort Study of Anticoagulation Self-Monitoring (CASM, UK)

"INR data was received from 273 participants (92.2% of the 296 who startedself-monitoring) and was analysed for 269 (90.9%). Median %TTR was 78.5% (IQR64.9–88.5). The older age groups had the highest %TTR. There was little difference in %TTR between those new to self-monitoring (median 76.1%, IQR 65.0–87.0) and those continuing to self-monitor (median 80.1%, IQR 64.8–91.4)."
Alison Ward et al, Br J Gen Pract 2015; Online first. DOI: 10.3399/bjgp15X685633

2015: Observational cohort study thrombEVAL (Germany)

"In patients performing self-management of OAC, TTR was detected to be at a higher level of quality in comparison to physician-guided OAC in both regular medical care and coagulation service treatment. In these patients, a high quality of therapy is obtained at the price of an approximately doubled frequency of INR control as compared to regular patients. Overall, levels of median TTR were higher for patients with self-management of OAC who were affiliated to a coagulation service as compared to regular medical care patients, although it did not reach a level of statistical significance 84.8% (49.0/83.6) vs. 86.0% (62.9/84.2; P = 0.075)."
©Prochaska et al.; licensee BioMed Central. 2015. BMC Medicine201513:14 DOI: 10.1186/s12916-015-0268-9