Patients should take over INR Self-Management

It has been more than 70 years since Karl Paul Link synthesized Coumarin in the USA. According to J. Ansell, MD, 1 – 2 % of the population of developed countries today takes anticoagulants to protect themselves from arterial and venous thromboembolisms (Circulation. 2012; 125: 165-170).

He continues: "The persistence of the drugs, even ones with many disadvantages such as Coumarins, states something about this compound. How many drugs can be named, which decrease the frequency of adverse outcomes caused by an abnormal rhythm of the heart, by two thirds?"

It is known that the intake of Vitamin-K-Antagonists must be monitored frequently in order to maintain the therapeutic range and therefore minimize potentially negative outcomes. Globally, these controls are mainly performed in laboratories, anticoagulation clinics and doctor’s offices.

Wouldn't it make sense to involve anticoagulation patients more in the responsibility to be in charge?
There is the possibility to transfer anticoagulation Self Management to patients.

C. Heneghan writes: "Our analysis shows that self-testing and self-management are a safe choice for appropriate patients of all ages" (Lancet, 2012; 379: 332-334).

Paul A. Kyrle et al, Vienna, comment the analysis of C. Heneghan in the same edition to the effect, that self-management should only be offered to patients with heart valves younger than 55 years of age. The authors also don’t see an opportunity for self-testing for other diseases where anticoagulation is required.

What about the 210,000 patients in Germany, and the important number INR self-testers in Europe and world wide who determine their INR values by themselves since years and decades? M. Nagler et al, presented results of a study (Hämostasiologie, 2012; 32, A77), where self-performed INR results are highly comparable with INR results from the laboratory.

Maybe one day, the cooperative relationship between physician and patient is good enough that reports of self-determined INR values suffice and additional controls at the doctor’s office are no longer necessary for patients without further medical problems.

Age limitation for INR Self-Testing/Management?

I am referring to your article "Patients should take over INR Self Management". In this article age limitations for self-testing are mentioned. Many elderly are perfectly capable to self-test. I am 82 years old and have been self-tester for many years.
I received a mechanical heart valve in 2003 and was made familiar with the testing procedure while still in the hospital. I am glad about this kind of control, since I have very bad veins and always problems with blood draws.
I test twice a week, because I am taking multiple medications and am able to react immediately when I have INR fluctuations. I have good control over my INR values, which is, thanks to my notes, confirmed by my doctor.
I see the mentioned limitation as a discrimination of age!
– G.K. Germany 

To the letter to the editor: "Age limitation for INR self-testing". I can agree 100 % with the writer. I will turn 83 years old this year and have been self-testing weekly since 2004 without problems so far.
– F.W.M./Germany


Christian Schaefer, ISMAAP