title: Self-management of oral anticoagulant therapy for mechanical heart valve patients.
abstract: OBJECTIVE
  Self-management of oral anticoagulant therapy (OAT) has shown good results on a short-term basis. We hypothesize that self-management of OAT provides a better quality of treatment than conventional management also on a long-term basis. The aim of this study was to assess the quality of self-management of OAT in patients with mechanical heart valve prostheses on a 4-year perspective in a prospective, non-randomized study.
  
  
  METHODS
  Twenty-four patients with mechanical heart valves and on self-managed OAT were followed for up to 4 years. A matched, retrospectively selected group of conventionally managed heart valve patients (control group) was used as reference.
  
  
  RESULTS
  The median observation time was 1175 days (range: 174-1428 days). The self-managed patients were within therapeutic INR target range for a mean of 78.0% (range: 36.1%-93.9%) of the time compared with 61.0% (range 37.4%-2.9%) for the control group.
  
  
  CONCLUSIONS
  Self-management of OAT is a feasible and safe concept for selected patients with mechanical heart valve prostheses also on a long-term basis. It provides at least as good and most likely better quality of anticoagulant therapy than conventional management assessed by time within the therapeutic International Normalized Ratio (INR) target range.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, and Institute of Experimental Clinical Research, Skejby Sygehus, Aarhus University Hospital, Denmark.
authors.forename: T D
authors.initials: TD
authors.lastname: Christensen
authors.forename: J
authors.initials: J
authors.lastname: Attermann
authors.forename: H K
authors.initials: HK
authors.lastname: Pilegaard
authors.forename: N T
authors.initials: NT
authors.lastname: Andersen
authors.forename: M
authors.initials: M
authors.lastname: Maegaard
authors.forename: J M
authors.initials: JM
authors.lastname: Hasenkam
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001780:Blood Coagulation Tests; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012646:Self Administration; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants