Certainly, some restrictions may apply, for instance, if the patient is suffering from Parkinson's or their vision decreases drastically, they would no longer be a candidate to test themselves. Even then, a partner or caregiver may be able to fill the gap by stepping in to perform the necessary testing instead of visits to the doctor or lab.
A review of some of the mentioned studies shows that:
- C. Heneghan wrote "Our analysis shows that the self-determination or self-management is a safe choice and is suitable for patients of all ages "(Lancet, 2012; 379; 322-334).
- But Paul A. Kyrle et al, Wien comment the analysis of C. Heneghan in the same issue to the effect that the self-management only for patients with prosthetic heart valves, which are less than 55 years, should be offered. The authors also do not see any place for the self-testing in other diseases where anticoagulation is required.
- Siebenhofer, A. et al (ThrombHaemost 2007; 97: 408-416) conducted a study in of older anticoagulated patients and whether they are able to handle INR self-management successfully. The average population age was 69 and they managed a TTR (time in the therapeutic range) of 75.4%.
- Alison Ward et al (in cooperation with the ISMAAP) found in their current study CASM (British Journal of General Practice, July 1, 2015), that anticoagulated patients over 70 years old were able to maintain TTRs above 85%.
- Thomas Davidson (J Telemed Telecare July 2015 vol. 21 no. 5298-301) investigated whether frail older anticoagulated patients in rural Swedish residential communities benefited by being tested at the point of care. The study found that these 86 year old residents achieved an average TTR of 75%.
The question of whether age and TTR are related has been an important topic in the minds of many researchers around the globe in the last few years.
A review of these publications makes apparent that self-management and the associated topic of self-testing at specific ages has an important place in the discussion around anticoagulation therapy. It seems clear that age is not a barrier to patient testing one’s INR values and that this self-testing is connected with a better quality of life.
Christian Schaefer (April 2016)