Self management of oral anticoagulation: randomised trial

doi:10.1136/bmj.38618.580903.AE

BMJ 2005;331:1057 (5 November), doi:10.1136/bmj.38618.580903.AE (published 10 October 2005)

Primary care

Self management of oral anticoagulation: randomised trial

D A Fitzmaurice, professor of primary care¹, E T Murray, research fellow¹, D McCahon, research associate¹, R Holder, head of statistics¹, J P Raftery, professor of health economics², S Hussain, statistician¹, H Sandhar, IT officer¹, F D R Hobbs, head of department¹

¹ Department of Primary Care, University of Birmingham, Birmingham, ² Health Services Management Centre, Birmingham B15 2RT

Correspondence to: D A Fitzmaurice d.a.fitzmaurice{at}bham.ac.uk

Objective To determine the clinical effectiveness of self managementcompared 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 warfarinrandomised to intervention (n = 337) and routine care (n = from2470 invited; 193/337 (57%) completed the 12 month intervention.

Intervention Intervention patients used a point of care deviceto measure international normalised ratio twice a week and asimple dosing chart to interpret their dose of warfarin.

Main outcome measure Percentage of time spent within the therapeuticrange of international normalised ratio.

Results No significant differences were found in percentageof time in the therapeutic range between self managment androutine care (70% v 68%). Self managed patients with poor controlbefore the study showed an improvement in control that was notseen in the routine care group. Nine patients (2.8/100 patientyears) had serious adverse events in the self managed group,compared with seven (2.7/100 patient years) in the routine carearm ( ${chi}$ ²(df = 1) = 0.02, P = 0.89).

Conclusion With appropriate training, self management is safeand reliable for a sizeable proportion of patients receivingoral anticoagulation treatment. It may improve the time spentthe therapeutic range for patients with initially poor control.

Trial registration ISRCTN 19313375.

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Rapid Responses:

Read all Rapid Responses

Better option for some third world countries: Jeevan P Marasinghe
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Self-management of oral anticoagulant therapy by portable coagulation monitors.: Giuseppe Lippi, et al.
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Warfarin and insulin; what's the difference?: Dave Hambidge
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and oh! so much more convenient for the PATIENT!: Julia Wyatt
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Still room for improvements?: Ulrike Didjurgeit, et al.
bmj.com, 14 Dec 2005 [Full text]
Re: Still room for improvements?: DA Fitzmaurice
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