title: A randomised control trial of patient self-management of oral anticoagulation compared with patient self-testing.
abstract: Several studies suggest that patient self-management (PSM) may improve the quality of oral anticoagulation therapy as measured by time spent within the international normalised ratio (INR) target range. We performed a prospective randomised control trial to determine whether the improvement in quality of treatment afforded by PSM is greater than that achieved by patient self-testing (PST) alone. A total of 104 of 800 eligible patients aged 22-88 years (median = 59.8), attending our hospital anticoagulant clinic and receiving long-term warfarin for >8 months agreed to participate. Patients were randomised to PSM (n = 55) or PST (n = 49). Both groups measured their INR using the CoaguChek S every 2 weeks or more frequently if required, for a period of 6 months. Seventy-seven of 104 (74%) patients completed the study (PSM = 41 and PST = 36). The 'drop out' rates for both groups were similar. There was no significant difference between the percentage time in target therapeutic range for PSM (69.9%) and PST (71.8%). Both groups combined showed a significant improvement over the previous 6 months (71.0% vs. 62.5%; P = 0.04). Changes in time within the therapeutic range in individual patients (+5.86) also showed a significant difference. The quality of warfarin control in both PST and PSM may be superior to that achieved by conventional management in a specialised hospital anticoagulation clinic.
authors.affiliation: Department of Haematology, University College London Hospitals, London, UK. chris.gardiner@uchevaluation.co.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Gardiner
authors.forename: Karen
authors.initials: K
authors.lastname: Williams
authors.forename: Ian
authors.initials: I
authors.lastname: Longair
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Mackie
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Machin
authors.forename: Hannah
authors.initials: H
authors.lastname: Cohen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011786:Quality Control; D012646:Self Administration; D012648:Self Care; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin