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Oral Anticoagulation Control: The European Perspective

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Abstract

We describe the results of a novel complete care package using point-of-care INR testing and computerized decision support for the management of oral anticoagulation by nurse-led primary care clinics in the United Kingdom. We found such therapy to be as safe and effective as traditional hospital-based care for oral anticoagulation in the UK as determined by adverse events or International Normalized Ratio (INR) time in range.

We then review the literature as it pertains to the safety, efficacy, and cost effectiveness of patient self-management with point-of-care INR testing at home and discuss the implications for such care in the UK.

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References

  1. 1.

    Sweeney KG, Pereira-Gray D, Steele R, Evans P. Use of warfarin in non-rheumatic atrial fibrillation: a commentary from general practice. British Journal of General Practice 1995;45:153–158.

  2. 2.

    Lowe GDO, Anti-thrombotic treatment and atrial fibrillation. Editorial. BMJ 1992;305;1445–1446.

  3. 3.

    Sudlow CM, Rodgers H, Kenny RA, Thomson RG. Service provision and use of anticoagulants in atrial fibrillation. BMJ 1995;311:558–561.

  4. 4.

    Sudlow M, Rodgers H, Kenny RA, Thomson R. Population based study of use of anticoagulants among patients with atrial fibrillation in the community. BMJ 1997;314:1529–1530.

  5. 5.

    Shakespeare J. Anticoagulation in patients with atrial fibrillation. GPs struggle to meet demand. BMJ 1994;308: 415.

  6. 6.

    Fitzmaurice DA, Hobbs FDR, Murray ET, Bradley CP, Holder R. Evaluation of computerized decision support for oral anticoagulation management in primary care. British Journal of General Practice 1996;46:533–535.

  7. 7.

    Ryan P, Gilbert M, Rose PE. Computer control of anti-coagulant dose for therapeutic management. BMJ 1989; 299:1207–1209.

  8. 8.

    Hobbs FDR. Near patient testing in primary care. BMJ 1996;312:263–264.

  9. 9.

    Oberhardt BJ, Dermott SC, Taylor M, Alkadi ZY, Abruzzini AF, Gresalfi NJ. Dry reagent technology for rapid, convenient measurements of blood coagulation and fibrinolysis. Clin Chem 1991;37:520–526.

  10. 10.

    Palareti G, Leali N, Coccheri S, et al. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 1996;348:423–428.

  11. 11.

    Fihn SD, McDonell M, Martin D, et al. Risk factors for complications of chronic anticoagulation. Ann Intern Med 1993:118:511–520.

  12. 12.

    van der Meer FJM, Rosendaal FR, Vandenbroucke Briet E. Bleeding complication in oral anticoagulant therapy. Arch Intern Med 1993:153:1557–1562.

  13. 13.

    Sawicki PT. A structured teaching and self-management program for patients receiving oral anticoagulation. A randomized controlled trial. JAMA 1999:281;145–150.

  14. 14.

    White R, McCurdy SA, von Marensdorff H, Woodruff DE, Leftgoff PA. Home prothrombin time monitoring after the initiation of Warfarin therapy. Ann Intern Med 1989;111:9:730–736.

  15. 15.

    Korfer R, Kortke H. ESCAT Early Self Controlled Anticoagulation Trial. Annals of Thoracic Surgery 2001;72:44–48.

  16. 16.

    Cromheecke ME, Levi M, Colly LP, et al. Oral anticoagulation self-management by a specialist anticoagulation clinic: a randomized cross-over comparison. Lancet 2000; 356:97–102.

  17. 17.

    Sidhu P, O'Kane HO. Self-managed anticoagulation: Results from a two-year prospective randomized trial with heart valve patients. Annals of Thoracic Surgery 2001; 72:1523–1527.

  18. 18.

    Hasenkam JM, Kimose HH, Knudsen L, et al. Self management of oral anticoagulation therapy after heart valve replacement; European Journal of Cardio-Thoracic Surgery 1997;11:935–942.

  19. 19.

    Ansell JE, Patel N, Ostrovsky D, Nozzolillo E, Peterson AM. Long term patient self management of oral anticoagulation. Arch Intern Med 1995;155:2185–2189.

  20. 20.

    Cosmi B, Palareti G, Carpanedo M, et al. Assessment of patient capability to self-adjust oral anticoagulant dose: a multicenter study on home use of portable prothrombin time monitor (COAGUCHEK). Haematologica 2000;85: 826–831.

  21. 21.

    Anderson DR, Harrison L, Hirsh J. Evaluation of a portable prothrombin time monitor for home use by patients who require long-term oral anticoagulant therapy. Arch Intern Med 1993;153:1441–1447.

  22. 22.

    Bernardo A. Experience with patient self-management of oral anticoagulation. J Thrombosis and Thrombolysis 1995;2:321–325.

  23. 23.

    Massicotte P, Marzinotto V, vegh P, Adams M, Andrew M. Home monitoring of warfarin therapy in children with a whole blood monitor. The Journal of Paediatrics 1995;127:389–394.

  24. 24.

    Stamper G, Toth P. Patient self testing for Prothrombin time using the Coaguchek system–-A feasibility study; Clinical chemistry 1996;42:6;10.1–10.7.

  25. 25.

    Lucas FV, Duncan A, Jay R, et al. A novel whole blood capillary technic for measuring the prothrombin time. Am J Clin Path 1987;88:442–446.

  26. 26.

    Van den Besselar AMHP, Breddin K, Parker-Williams, et al. Multicenter evaluation of a new capillary blood prothrombin time monitoring system. Blood Coagul Fibrinolysis 1995;6:726–732.

  27. 27.

    Taborski VWE, Wittstamm FJ, Bernardo A. Cost-effectiveness of self-management anticoagulant therapy in Germany. Seminars in Thrombosis and Haemostasis 1999;25:10–107.

  28. 28.

    Fitzmaurice DA, Murray ET, Gee KM, Allan TF, Hobbs FDR. A randomized controlled trial of patient self-management of oral anticoagulation treatment compared with primary care management. J Clin Pathol 2002;55:845–849.

  29. 29.

    Fitzmaurice DA, Murray ET, Hobbs FDR, MacCahon. Self-management of anticoagulation: a randomized trial. BJ Haem 2004;125(Suppl 1):56.

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Correspondence to David A Fitzmaurice M.D..

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Fitzmaurice, D.A. Oral Anticoagulation Control: The European Perspective. J Thromb Thrombolysis 21, 95–100 (2006). https://doi.org/10.1007/s11239-006-5584-7

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Key Words

  • oral anticoagulation
  • point-of-care testing
  • INR