title: Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.
abstract: Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years). Median age at the time of training was 54.2 years (range 18.2-85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p<0.001), patients>50 years of age (2.0; 1.6-2.6; p<0.001), and men (1.6; 1.2-2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2-0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.
authors.affiliation: Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, and Department of Haematology and Central Haematology Laboratory, Inselspital University Hospital, Berne, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Nagler
authors.affiliation: medignition Inc., Zug, Switzerland.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
authors.affiliation: Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Pirmin
authors.initials: P
authors.lastname: Schmid
authors.affiliation: Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Pascale
authors.initials: P
authors.lastname: Raddatz Müller
authors.affiliation: Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, 6000 Lucerne, and University of Berne, Berne, Switzerland.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Wuillemin
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012648:Self Care; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin
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