Home management of INR in the public health system: feasibility of self-management of oral anticoagulation and long-term performance of individual POC devices in determining INR

Saraiva, Sabrina da Silva; Orsi, Fernanda Andrade; Santos, Marcos Pereira dos; Machado, T. F. G. S.; Montalvão, Silmara Aparecida de Lima; Costa-Lima, Carolina; Paula, Erich Vinícius De; Colella, Marina Pereira; Annichino‐Bizzacchi, Joyce Maria

doi:10.1007/s11239-016-1335-6

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…31,36 We have previously evaluated the anticoagulation related QOL using the DASS score in cohort of patients with previous thrombosis (not PAPS-related). 37 The median DASS score in that population was 64,18, which is higher than that observed in PAPS patients (median DASS score was 55 in PAPS). Furthermore, we compared our results with that of two other Brazilian studies in which the SF-36 questionnaire was used to assess HRQOL in atrial fibrillation or prosthetic valve patients taking VKA.…”

Section: Discussionmentioning

confidence: 53%

“…39 We have previously evaluated the feasibility of a warfarin self-management program in our institution, which is a public health medical center that provides care for low-income patients. 37 Warfarin self-management was feasible for the majority of the patients and did not affect their time in therapeutic range negatively. However, this approach did not change their self-perception of HRQOL, which was evaluated by the DASS instrument.…”

Section: Discussionmentioning

confidence: 96%

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Self-perceived quality of life of primary antiphospholipid syndrome patients using vitamin K antagonist

Vaz

Mazetto

Vasconcelos

et al. 2021

Lupus

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Purpose Primary antiphospholipid syndrome (PAPS) is a chronic autoimmune disorder clinically characterized by thromboembolic events or obstetric complications. Prolonged anticoagulation therapy with vitamin K antagonists (VKA) is the treatment of choice for PAPS patients with thrombosis. However, the efficacy of VKA therapy depends on laboratory monitoring, dose adjustment, adequate lifestyle and adherence to treatment. Difficulties with VKA therapy can affect patients’ self-perceived health related quality of life (HRQOL). This study aims to evaluate PAPS patients' HRQOL, therapy adherence and knowledge of treatment. Methods A general Medical Outcome Study Short Form-36 (SF-36) and the Duke Anticoagulation Satisfaction Scale (DASS) were used to access APS-patients self-perceived HRQOL. Treatment adherence was measured by the Treatment Measure Adhesion (TMA) – oral anticoagulant version instrument, and knowledge of VKA treatment was measured using the MedTake test. Results 66 PAPS patients using VKA were assessed. 63% of them were female; the mean age was 41.9 years old, approximately 60% had unprovoked venous thrombosis and one third of the patients had recurrent thrombotic events. The most impacted domain of DASS was “psychological impacts” and the factors associated to anticoagulation related poor HRQOL were: female sex, presence of arterial thrombosis and INR lability. Using the SF-36 instrument, PAPS-patients self-perceived HRQOL was poorer than that of the general Brazilian population and was associated with female sex and presence of cardiovascular risk factors. Conclusion Despite the high adherence to treatment and knowledge of VKA therapy, self-perceived HRQOL is poor in patients with PAPS and is mainly affected by VKA therapy. Searching for better treatment options is warranted.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 96%

Self-perceived quality of life of primary antiphospholipid syndrome patients using vitamin K antagonist

Vaz

Mazetto

Vasconcelos

et al. 2021

Lupus

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“…9,[12][13][14] It has been proven that the CoaguChek device is safe for INR measurement, [15][16][17] and both methods had a high correlation coefficient (r ¼ 0.94, 95% confidence interval [CI]: 0.91-0.96; p < 0.01). 18 A study comparing 234 INR measurements by either the CoaguChek (median INR: 3.02) or laboratory testing (median INR: 3.07) found no differences between the methods. 19 A meta-analysis pointed out that the use of point-of-care devices (POCD) was safe and might be more effective than laboratory-based monitoring.…”

Section: Discussionmentioning

confidence: 99%

Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device

Vogeler

Dieterlen

Garbade

et al. 2020

Thorac Cardiovasc Surg

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Background The exact monitoring of the therapeutic-range international normalized ratio (INR) after left ventricular assist device (LVAD) implantation is an important aim to reduce the risk of thrombosis or bleeding complications. Service providers offer a telemedical anticoagulation service (CS). Methods We compared LVAD patients using the CS (n = 15) to those who received regular medical care (RMC; n = 15) to investigate if telemedicine supervision increased the INR-specific time in the therapeutic range (TTR) during anticoagulation. All patients received self-management training for phenprocoumon medication according to their INR value. INR values were documented for 12 months. A survey (scale: 1 = not satisfied and 10 = very satisfied) was used to determine patient's satisfaction and psychological well-being. Results A total of 1,798 INR measurements were analyzed. The TTRRosendaal was higher in patients undergoing RMC (78.1 ± 14.3%) compared with that in patients using the CS (58.3 ± 28.0%, p = 0.03). The patient's satisfaction with the coagulation setting at the beginning of the study (RMC: 6.7 ± 3.1, CS: 7.2 ± 3.0, p = 0.74) and psychological wellbeing (RMC: 6.5 ± 1.9, CS: 6.5 ± 2.7, p = 0.97) were comparable between both groups. Conclusion We found that INR self-management is superior regarding the efficiency of post-LVAD anticoagulation therapy when compared with telemedical (CS)-based INR management in a small study cohort. Intensive training by experienced staff was able to replace CS.

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“…An alternative option would be for patients to regularly monitor their own Hct levels at home. Self-testing devices for home use are available and deliver good outcomes for other chronic medical conditions (e.g., blood glucose monitoring for patients with diabetes [ 13 ] or international normalized ratio monitoring in anticoagulated patients [ 14 ]). Additionally, while empowering patients to take more control of their disease management has been shown to lead to reduced consultations and improved disease outcomes and overall survival in oncology patients [ 15 , 16 , 17 , 18 ], there are currently no approved devices on the market that are suitable for patient use and that measure Hct directly (i.e., do not use Hb as an indirect measure of Hct).…”

Section: Introductionmentioning

confidence: 99%

“…The following supporting information can be downloaded at: . Supplementary Information S1: Patient questionnaire after the self-test with the StatStrip Xpress 2 LAC Hb/Hct meter; Supplementary Information S2: Healthcare professional questionnaire at the study’s conclusion; Supplementary Information S3: Study protocol [ 14 , 15 , 16 , 19 , 20 , 22 , 23 , 24 ].…”

mentioning

confidence: 99%

Hematocrit Self-Testing in Patients with Polycythemia Vera and Other Hematological Conditions: Assessing the Accuracy of the StatStrip Xpress® 2 LAC/Hb/Hct Device and User Opinion about the Device in Real-World Clinical Practice

Rovó

Baierlein-Leimbach

Medri

et al. 2022

JCM

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Maintaining hematocrit (Hct) levels below 45% can reduce morbidity and mortality in patients with polycythemia vera (PV). A device that patients can use to self-monitor Hct levels could enable timely interventions if Hct levels increase above 45%, and could improve quality of life (QoL). This study evaluated the accuracy of the StatStrip Xpress® 2 LAC/Hb/Hct meter (Hb/Hct meter) when used by healthcare professionals (HCPs) or patients in clinical practice. Blood samples from 68 visits for 60 patients with PV or other hematological conditions were collected and analyzed by HCPs using a laboratory hematological analyzer, and by patients (self-test) and HCPs (professional test) using the Hb/Hct meter at two Swiss centers. Accuracy was assessed as the mean difference in readings between two users/methods (mdiff, 90% confidence interval; Spearman correlation [r]). The Hct values were similar between the professional test and analyzer (n = 66 comparisons, mdiff = 0.1% [−0.5 to 0.8]; r = 0.95, p < 0.001), the self-test and professional test (n = 62 comparisons, mdiff = −0.2% [−1.1 to 0.7]; r = 0.93, p < 0.001), and the self-test and analyzer (n = 63 comparisons, mdiff = 0.0% [−0.8 to 0.7]; r = 0.94, p < 0.001). The hemoglobin values across users/methods were also similar. Reporting their opinion on the Hb/Hct meter at visit 1, 100% of the patients found it easy to use, and 97% were willing to use it at home. Of the patients with PV, approximately 71% and 56%, respectively, stated that they would feel safer using a self-testing device, and that it would improve their QoL. These findings demonstrate the potential of the Hb/Hct meter for HCP and patient use in real-world settings.

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Home management of INR in the public health system: feasibility of self-management of oral anticoagulation and long-term performance of individual POC devices in determining INR

Cited by 7 publications

References 34 publications

Self-perceived quality of life of primary antiphospholipid syndrome patients using vitamin K antagonist

Self-perceived quality of life of primary antiphospholipid syndrome patients using vitamin K antagonist

Benefit of Self-Managed Anticoagulation in Patients with Left Ventricular Assist Device

Hematocrit Self-Testing in Patients with Polycythemia Vera and Other Hematological Conditions: Assessing the Accuracy of the StatStrip Xpress® 2 LAC/Hb/Hct Device and User Opinion about the Device in Real-World Clinical Practice

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