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Clinical Trial
. 2005 Nov 5;331(7524):1057.
doi: 10.1136/bmj.38618.580903.AE. Epub 2005 Oct 10.

Self management of oral anticoagulation: randomised trial

D A Fitzmaurice  1 , E T Murray, D McCahon, R Holder, J P Raftery, S Hussain, H Sandhar, F D R Hobbs
Affiliations
Clinical Trial

Self management of oral anticoagulation: randomised trial

D A Fitzmaurice et al. BMJ. .

Erratum in

  • BMJ. 2005 Dec 3;331(7528):1330

Abstract

Objective: To determine the clinical effectiveness of self management compared 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 warfarin randomised to intervention (n = 337) and routine care (n = from 2470 invited; 193/337 (57%) completed the 12 month intervention.

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

Main outcome measure: Percentage of time spent within the therapeutic range of international normalised ratio.

Results: No significant differences were found in percentage of time in the therapeutic range between self management and routine care (70% v 68%). Self managed patients with poor control before the study showed an improvement in control that was not seen in the routine care group. Nine patients (2.8/100 patient years) had serious adverse events in the self managed group, compared with seven (2.7/100 patient years) in the routine care arm (chi2(df = 1) = 0.02, P = 0.89).

Conclusion: With appropriate training, self management is safe and reliable for a sizeable proportion of patients receiving oral anticoagulation treatment. It may improve the time spent the therapeutic range for patients with initially poor control. Trial registration ISRCTN 19313375.

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Figures

Figure 1
Figure 1
Flowchart of study
See this image and copyright information in PMC

References

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