title: Cohort study of Anticoagulation Self-Monitoring (CASM): a prospective study of its effectiveness in the community.
abstract: BACKGROUND
  Trials show that oral anticoagulation therapy (OAT) substantially reduces thromboembolic events without an increase in major haemorrhagic events, but it is not known whether these results translate into routine practice.
  
  
  OBJECTIVE
  To estimate the current levels of control and adverse events in patients self-monitoring OAT, explore the factors that predict success, and determine whether the level of side effects reported from randomised controlled trials are translated to a non-selected population.
  
  
  METHODS
  Prospective cohort study in the UK.
  
  
  METHODS
  Participants were aged ≥18 years and registered with a GP. Main outcomes were the proportion of participants, over 12 months, who were still self-monitoring, had not experienced adverse events, and had achieved >80% of time in therapeutic range (TTR).
  
  
  RESULTS
  In total, 296 participants were recruited; their median age was 61 years and 55.1% were male. Participants were predominately professional or held a university qualification (82.7%). At 12 months, 267 (90.2%) were still self-monitoring. Mean TTR was 75.3% (standard deviation 16.9).Six serious and two minor adverse events were reported by GPs. Only 45.9% of participants received any in-person training at the outset. Increased age (P = 0.027), general wellbeing (EQ-5D visual score, P = 0.020), and lower target international normalised range (INR, P = 0.032) were all associated with high (>80% TTR) levels of control.
  
  
  CONCLUSIONS
  The findings show that, even with little training, people on OAT can successfully self-monitor, and even self-manage, their INR. TTR was shown to improve with age. However, widespread use of self-monitoring of INR may be limited by the initial costs, as well as a lack of training and support at the outset.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Alison
authors.initials: A
authors.lastname: Ward
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Alice
authors.initials: A
authors.lastname: Tompson
authors.affiliation: University of Birmingham, Edgbaston.
authors.forename: David
authors.initials: D
authors.lastname: Fitzmaurice
authors.affiliation: Institute of Public Health, University of Cambridge, Cambridge.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sutton
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
mesh_terms: D000284:Administration, Oral; D000359:Aftercare; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012646:Self Administration / Q000379:methods*; D013923:Thromboembolism / Q000517:prevention & control*; D006113:United Kingdom; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; monitoring; primary care; self-management; self-monitoring