Patient Self-Management of Oral Anticoagulant Therapy: An International Update

The clinical use of oral anticoagulant therapy has been complicated by the necessity for frequent determinations of the prothrombin time (PT) to ensure safety and therapeutic efficacy. This requirement has often imposed a significant burden on both providers and patients. In 1985 a German patient, Heike Möller-Jung, initiated her own patient self-testing (PST) and patient self-management (PSM). Today there are over 15,000 patients in Germany managing their oral anticoagulant therapy with PSM options. Pilot PST and PSM programs are in place in many other countries. In the United States, two devices have recently been approved for PST. This method of monitoring has been shown to be as accurate as that of traditional central laboratory PT determinations, to improve the amount of time patients are within the therapeutic INR range, and to decrease the incidence of adverse events associated with anticoagulant therapy.