Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

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 (χ2(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.

Original publication




Journal article


British Medical Journal

Publication Date





1057 - 1059