Workshop: Patient Self-Management: Update of Ongoing Studies in Sweden

Anti-vitamin K (AVK) therapy (e.g., warfarin) requires regular blood tests for adequate dosing of the drug. The therapeutic window for these drugs is narrow, with a risk of bleeding if the dose is too high and of thrombotic complications if the dose is too low. Moreover, the required dose to achieve an optimal level of anticoagulation is individual and depends on such factors as the general health of the patient, food intake, and concomitant medication. Although control requires regular monitoring, most patients are reluctant to visit an anticoagulation clinic (ACC) more than 6-12 times yearly because each visit costs the patient both money and time. The development of prothrombin time (PT) monitors that are simple to operate and highly portable has made self-management possible for large groups of patients on long-term AVK therapy. Self-management increases the safety of AVK therapy through frequent testing (3-4 times per month) and timely dose adjustments when they are indicated. The concept of self-management of AVK therapy was introduced in Germany a decade ago with great success. Swedish patient education in self-management was started in September 1996. As of May 1997, 38 patients have completed the training program, 37 of whom have continued with self-management. Experience with the first seven groups of patients has convinced us that self-management is possible and has great potential. Randomized controlled studies are needed to determine the cost effectiveness of self-management with regard to a reduction in bleeding and thrombotic complications.