title: Predictors of anticoagulation quality in 15 834 patients performing patient self-management of oral anticoagulation with vitamin K antagonists in real-life practice: a survey of the International Self-Monitoring Association of Orally Anticoagulated Patients.
abstract: Although patient self-management (PSM) of oral anticoagulation with vitamin K antagonists is recommended for patients requiring long-term anticoagulation, important aspects are still unclear. Using data from a large international survey (n = 15 834; median age 72 years; 30·1% female), we studied predictors of poor anticoagulation control (percentage of International Normalized Ratio values within therapeutic range below 75%) and developed a simple prediction model. The following variables were identified as risk factors for poor anticoagulation control and included in the final model: higher intensity of therapeutic range (odds ratio [OR] on every level 1·9; 95% confidence interval [CI] 1·8-2·0), long intervals between measurements (>14 d; 1·5; 95% CI 1·3-1·7), female sex (OR 1·3; 95% CI 1·2-1·4), and management other than PSM (OR 1·4; 95% CI 1·2-1·6). At a threshold of 0·2 (at least one variable present), the model predicted poor anticoagulation control with a sensitivity of 85·3% (95% CI: 84·0, 86·4) and a specificity of 28·5% (27·6, 29·5). The area under the receiver operated characteristic curve was 0·65. Using the proposed prediction model, physicians will be able to identify patients with a low chance of performing well, considering additional training, regular follow-up, or adjustment of therapeutic ranges.
authors.affiliation: International Self-Montioring Association of Oral Anticoagulated Patients (ISMAAP), Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schaefer
authors.affiliation: Division of Haematology and Central Haematology Laboratory, Luzerner Kantonsspital, University of Bern, Bern, Switzerland.|University of Bern, Bern, Switzerland.
authors.forename: Walter A
authors.initials: WA
authors.lastname: Wuillemin
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Alfons
authors.initials: A
authors.lastname: Kessels
authors.affiliation: Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Jacobson
authors.affiliation: University Clinic of Haematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Clinical Research, University of Bern, Bern, Switzerland.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-4319-2367
authors.initials: M
authors.lastname: Nagler
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: International Normalized Ratio; anticoagulant administration/dosage; drug monitoring; self care; vitamin K antagonists/inhibitors