Self management for oral anticoagulation

Evidence-Based Management of Anticoagulant Therapy

“…[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] The absolute difference in TTR between AMS and pletion. 67 THINRS was more promising in that ‫ف‬ 80% were able to pass a PST competency assessment, but 16% switched from PST to the clinic testing group during the study. 73 Recommendation…”

“…If the patients who perform their own INR testing also adjust their anti coagulant dose, this is called patient self-management (PSM). 67 Several systematic reviews have evaluated RCTs of PST/PSM to determine whether these approaches to oral anticoagulation therapy result in better clinical outcomes than traditional laboratory-based INR monitoring. [67][68][69][70][71] A recent individual patient metaanalysis clarifi ed several aspects; our recommendations are based primarily on this more-detailed analysis.…”

“…67 Several systematic reviews have evaluated RCTs of PST/PSM to determine whether these approaches to oral anticoagulation therapy result in better clinical outcomes than traditional laboratory-based INR monitoring. [67][68][69][70][71] A recent individual patient metaanalysis clarifi ed several aspects; our recommendations are based primarily on this more-detailed analysis. 72 Pooled analyses show a signifi cant reduction in the rate of thromboembolic complications with PST/PSM but not in the rate of major bleeding or overall mortality compared with usual laboratory-based INR would be of greater interest to evaluate the effect of daily vitamin K supplementation in a population with unstable INRs that are not due to other correctable factors.…”

Self-management: One size does not fit all

“…In DM-II, improvements in glycaemic control seem more pronounced when psychosocial behavioral techniques are used 20;21 . The addition of self-adjusted therapy in patients on oral coagulation seems dominant compared to self-monitoring alone in terms of a slightly greater reduction in thromboembolic events and mortality 16 . …”

“…Table 1 illustrates the pooled evidence from meta-analyses emerging, which indicates that self-management in patients with, asthma 10 , chronic heart failure 11 , COPD 12 , diabetes type-2 (DM-II) 13 , hypertension 14 , musculoskeletal pain 15 and patients on oral anticoagulation 16 improves a variety of outcomes such as improved disease-specific outcomes, quality of life, self-management behavior, and reduced healthcare costs. Given these encouraging results one might conclude that nothing should prevent policy makers and healthcare professionals from robust implementation of self-management in routine care.…”