Self management of oral anticoagulation: Randomised trial
Fitzmaurice DA., Murray ET., McCahon D., Holder R., Raftery JP., Hussain S., Sandhar H., Hobbs FDR.
Objective: To determine the clinical effectiveness of self management compared with routine care in patients on long term oral anticoagulants. Design: Multicentre open randomised controlled trial. Setting: Midlands region of the UK. Participants: 617 patients aged over 18 and receiving warfarin randomised to intervention (n = 337) and routine care (n = 280) from 2470 invited; 193/337 (57%) completed the 12 month intervention. Intervention: Intervention patients used a point of care device to measure international normalised ratio twice a week and a simple dosing chart to interpret their dose of warfarin. Main outcome measure: Percentage of time spent within the therapeutic range of international normalised ratio. Results: No significant differences were found in percentage of time in the therapeutic range between self managment and routine care (70% v 68%). Self managed patients with poor control before the study showed an improvement in control that was not seen in the routine care group. Nine patients (2.8/100 patient years) had serious adverse events in the self managed group, compared with seven (2.7/100 patient years) in the routine care arm (χ 2 (df = 1) = 0.02,P = 0.89). Conclusion: With appropriate training, self management is safe and reliable for a sizeable proportion of patients receiving oral anticoagulation treatment. It may improve the time spent within the therapeutic range for patients with initially poor control.