Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation

International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation (ISMAA).

This document provides health care professionals involved in initiating and monitoring oral anticoagulation therapy with guidelines for the provision of safe and effective patient self-testing/patient self-management of oral anticoagulation.

Methods and results:
The consensus group has critically reviewed the literature and compared the results of usual care (UC) vs. anticoagulation clinic and patient self-management/patient self-testing (PSM/PST). The education and training of patients for self-monitoring are described, together with the suitability of patients, the effect on quality of life and cost-effectiveness. The consensus agrees that patient self-testing and patient self-management are effective methods of monitoring oral anticoagulation therapy, providing outcomes at least as good as, and possibly better than, those achieved with an anticoagulation clinic. All patients must be appropriately selected and trained. Currently available self-testing/self-management devices give INR results which are comparable with those obtained in laboratory testing. The most frequent testing frequency is weekly but lower frequency of testing can be justified based on institutional or patient conditions.

The consensus agrees that there are several points in favour of PST/PSM, for example, a higher degree of medical safety, increased patient education, improved response to changes in lifestyle, increased independence for the patient and improved quality of life.

Ansell J, Jacobson A, Levy J, Völler H, Hasenkam JM; International Self-Monitoring Association for Oral Anticoagulation. Department of Medicine, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.
Journal of Cardiology, 2005; 99:37-45