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 privat laboratory for measurement of INR.
In Germany, anticoagulation self-management is established since about 1987. Since then about 200.000 patients receiving oral anticoagulant therapy have been trained in using a self-monitoring system and successfully perform self-testing for control of INR.
The health insurances usually pay the costs for this selfmanagement for the following patient groups:
- patients with mechanical heart valve replacement;
- children on anticoagulation;
- patients on lifelong anticoagulation because of artial fibrillation, recurrent thromboembolism etc. and at least one of the following indications;
- difficult peripherial veins;
- complications during treatment with an vitamin-K-antagonist like bleeding or thromboembolism;
- inability to get to the general practitioner because of immobility.
It has been shown in several studies(1,3,5), that under self-management of oral anticoagulation with vitamin-k-antagonists the frequency of severe complications like bleeding and thromboembolism is much lower than in conventionally controlled patients.
The reason for this is a much higher percentage of INR values lying in target range compared with the conventional patient group(3).
It also could be shown, that in patients with mechanical heart valve replacement the self-management of anticoagulation leads to a significant increase of long term survival in these patients of about 23 %(2).
Furhtermore selfmanagement of anticoagulation is much cheaper for the german health system (686,39 €/year in patients on selfmanagement vs. 1054,92 €/year in conventionally controlled patients) due to reduction of hospitalization, surgery and rehabilitation in case of bleeding and thromboembolic complications(4).
1Heidinger KS et al: “Clinical outcome of self-management of oral anticoagulation in patients with atrial fibrillation or deep vein thrombosis”. Thrombosis Research 2000;98:287-93
2Koertke H et al: “Self-management of oral anticoagulatoin therapy improves long-term survival in patients with mechanical heart valve replacement.” Ann Thorax Surg 2007;83:24-9
3Siebenhofer A et al:”Self-Mangagement of oral anticoagulation in the elderly: rationale, design, baselines and oral anticoagulation control after one year of follow-up.” Thromb Haemost 2007;97:408-16
Dr. med. Hannelore Rott, Specialist in Transfusion Medicine,
Königstr. 53, 47051 Duisburg/Germany (July 2007)