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Self-management program improves anticoagulation control and quality of life: a prospective randomized study
Mohamed A Soliman Hamad1, Ellen van Eekelen, Ton van Agt
1Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Summary
Patient self-management of oral anticoagulants, using CoaguChek devices, significantly improves international normalized ratio (INR) control after mechanical aortic valve replacement compared to conventional care. Quality of life also improved, particularly physical function, in the self-management group.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Retrospective studies suggest patient self-management of oral anticoagulants enhances therapeutic control.
- Effective management of oral anticoagulants is crucial for patients with mechanical heart valves.
Purpose of the Study:
- To prospectively evaluate the impact of patient self-management on anticoagulant therapy control and quality of life.
- To compare self-management with conventional management by a Dutch Thrombosis Service.
Main Methods:
- A prospective randomized study involving 62 patients undergoing elective mechanical aortic valve replacement.
- Patients were randomized into conventional management (Thrombosis Service) or self-management (CoaguChek) groups.
- Primary endpoints included international normalized ratio (INR) values within the target range and SF-36v2 quality of life scores at one year.
Main Results:
- The self-management group achieved a significantly higher percentage of INR values within the target range (72.9%) compared to the conventional group (53.9%; p=0.01).
- Both groups reported improved quality of life postoperatively.
- The self-management group showed a statistically significant improvement in the physical component summary of quality of life (p=0.001).
Conclusions:
- Patient self-management, following adequate training, improves INR control even with established services like the Dutch Thrombosis Service.
- Self-management led to significant improvements in physical quality of life post-surgery.
- Further research is warranted to assess the impact of self-management on bleeding and thrombo-embolic event risks.
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