Patient should take over 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. Kyle 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 180,000 patients in Germany, and the many self-testers in Switzerland and Austria who determine their INR values by themselves since years and decades? M. Nagler et al, presented results of a study (Hämostasiologie, 2012; 32, A77) at the GTH-Congress in St. Gallen beginning of February, 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.

Christian Schaefer (April, 2012)