Home monitoring of anticoagulation.
Small portable devices that generate a prothrombin time/INR from fingerstick capillary blood simplify warfarin management by allowing selected patients to monitor and manage their own warfarin dose. Early studies established that patients can self-test at home, with results as accurate as those obtained by practitioners. Point-of-care testing of elderly patients resulted in tighter INR control and a lower incidence of major hemorrhage, especially at the initiation of anticoagulant therapy. Patients can also successfully self-manage warfarin therapy. Larger, prospective, randomized intervention studies have shown that patient self-management led to greater time spent within the therapeutic INR range. However, a shift toward patient self-testing will likely require centralized implementation of patient education, training, and follow up that will need to be established in the clinic setting or by a third party.
Hambleton
Julie
J
Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA, 94143-1270, USA. jsh@medicine.ucsf.edu
D000925:Anticoagulants / Q000627:therapeutic use*; D006699:Home Care Services / Q000592:standards; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards; D012648:Self Care / Q000379:methods / Q000592:standards
D000925:Anticoagulants