Management of longtime Anticoagulation

World-wide, millions of patients live under oral anticoagulation. However, only 300.000 of these patients practice the INR self-management. With around 200.000 patients the greater part of the self-management patients lives in Germany. This fact was the reason for the magazine “coagulation” to start a reader survey in order to estimate the quality of the oral anticoagulation management. Altogether, 10.000 questionnaires could be evaluated.

Method:
The questionnaires were sent to the readers of the magazine “coagulation”. Every questionnaire contained among other things the following questions regarding age, sex, professional activity, therapeutic target area, the kind of diagnosis and INR-Management (self-management or carried out by the family doctor), details about the last 10 measured values and the time intervals in which the coagulation values were determined. Additional questions were

  • How often do you have the values controlled additionally by your family doctor?
  • Did you have complications during the past year, which led to a stationary hospitalization?
  • Did you have to deal with high anticoagulation variability?

Results:
We received 10.000 questionnaires from 7085 males and 2750 females and 165 with no indication. The mean of age is 62.911.08 years. Because of the distribution of the coagulation magazine, 98.2% of the readers belonged to the self-management while only 1.8% belonged to the conventional group. The more precise term “INR” was used in 85% of the former and in only 59% of the latter group (Figure 1). In the self-management group 70.8% of the INR values lay within the predetermined INR range in comparison to 62.3% of values in patients conventionally controlled (Figure 2). Less INR variability was associated with a lower complication rate (5%) than higher INR variability (7.3%) (Figure 3). Measurements were performed weekly in 59.7% and every 2 weeks in 21.2% of patients practicing self-management, while in the conventional group measurements were mainly taken every 3 or 4 weeks (21.2% and 34.8%, respectively) and less in weekly intervals (18.5%) (Figure 4). Interestingly, no physician was consulted in 14.6% of self-management patients indicating a high rate of self-confidence.

Conclusion:
INR-Self-management leads to a higher grade of informational and educational status, thereby improving compliance of anticoagulation therapy, lowering complication rates and improving quality of life.

Heinrich Koertke1, Christian Schaefer2, Otto Wagner1, Mahmoud El-Arousy1, Reiner Koerfer1

1Heart and Diabetes Center Northrhine Westphalia, Germany, Clinic for Thorax- und Cardiovascularsurgery, Bad Oeynhausen, Clinic of the Ruhr-University Bochum.
2"Die Gerinnung" ("The Coagulation") magazine

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