Patient self-management of oral anticoagulation: a review.
Self-management of warfarin is an evolving strategy that involves self-testing of the international normalized ratio using a point-of-care device and adjustment of warfarin dosage by the patient using a dosage-adjustment nomogram. There is mounting evidence from clinical trials that self-management of warfarin is feasible and is potentially superior to conventional management by physicians in maintaining anticoagulation control. Some advantages of this strategy are convenience, rapid availability of results with timely adjustment of warfarin dosages, increased patient responsibility for their own therapy and enhanced patient satisfaction. Access to point-of-care instruments may prove particularly valuable for patients without ready access to laboratories, frequent travellers who are often away from their home laboratory for extended periods of time and those who experience difficulties with venous blood collection. Self-management may be considered for carefully selected and properly trained individuals. Information from several ongoing clinical trials will aid in determining the value of anticoagulation self-management with respect to complication rates and economic outcomes.
Sunderji
Rubina
R
Vancouver General Hospital and University of British Columbia, Vancouver, Canada.
Fung
Anthony
A
Gin
Kenneth
K
Shalansky
Karen
K
Carter
Cedric
C
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005060:Europe; D006801:Humans; D019934:International Normalized Ratio; D009656:North America; D012648:Self Care; D013923:Thromboembolism / Q000188:drug therapy; D006113:United Kingdom; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin