Improvement of Oral Anticoagulation Therapy by INR Self-Management Dieter Horstkotte, Cornelia Piper |
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Thromboembolic complications after valve replacement are significantly reduced if the INR is increased from 1.0 to 2.0. Hemorrhagic events increase exponentially with more intensive oral anticoagulation. In INR (patient) self-testing (PST), patients self-check their INR after being appropriately educated and supplied with a coagulometer. Patients contact their home physician if the actual INR tends to run outside an individually defined target INR corridor for correction. For patient self-management (PSM), subjects are trained to self-test their INR and to adjust the anticoagulant dose according to their anticoagulation state. The median difference between self-tested and laboratory-tested INRs was <5.0%, indicating no significant differences between the two methods. PSM resulted in a significantly more stable oral anticoagulation therapy (OAT), which was the strongest predictor for a low complication |
rate after valve replacement surgery. Lower rates of thromboembolism
(0.9 versus 3.6% per patient-year; pt-yr) and bleeding (4.5 versus 10.9%
per pt-yr) (p <0.001) were seen in PSM subjects than with conventional
INR management. A switch from conventional to PSM resulted in a 30% reduction
in complication rates in the German Experience with Low Intensity Anticoagulation
(GELIA) study. After appropriate education and provision with a handy coagulometer,
the vast majority of patients after valve replacement can self-check INRs
and adjust the anticoagulant dosage accordingly. PSM results in a significantly
more stable oral anticoagulation treatment and consequently in lower incidences
of thromboembolic and bleeding events. The Journal of Heart Valve Disease 2004;13:335-338 |
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