Home prothrombin time monitoring: A literature analysis

“…Oral anti-coagulant therapy (OAT) is indicated for several medical conditions such as atrial fibrillation (AFib), mechanical heart valve prostheses, deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke [3]. It has however been particularly recommended for patients and especially the elderly who may have or be at risk of having a stroke or AFib, to prevent and treat thromboses [4].…”

Section: Introductionmentioning

confidence: 99%

Patients' perspectives on self-testing of oral anticoagulation therapy: Content analysis of patients' internet blogs

Shah

Robinson

2011

BMC Health Serv Res

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BackgroundPatients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.MethodsInternet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages.ResultsThe key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT.ConclusionsPatients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum particularly for patients with chronic illness.

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“…Finally, various other strategies have been suggested to improve the safety of anticoagulation therapy including computer decision support systems, 123 the use of patient self-monitoring devices 124 and the use of drugs that inhibit other targets in the anticoagulation pathway, for example the oral thrombin inhibitors. 125 Whether we should use pharmacogenetic-based warfarin therapy in competition or in conjunction with these other approaches is not clear.…”

Section: Wadelius and M Pirmohamedmentioning

confidence: 99%

Pharmacogenetics of warfarin: current status and future challenges

2006

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Warfarin is an anticoagulant that is difficult to use because of the wide variation in dose required to achieve a therapeutic effect, and the risk of serious bleeding. Warfarin acts by interfering with the recycling of vitamin K in the liver, which leads to reduced activation of several clotting factors. Thirty genes that may be involved in the biotransformation and mode of action of warfarin are discussed in this review. The most important genes affecting the pharmacokinetic and pharmacodynamic parameters of warfarin are CYP2C9 (cytochrome P 450 2C9) and VKORC1 (vitamin K epoxide reductase complex subunit 1). These two genes, together with environmental factors, partly explain the interindividual variation in warfarin dose requirements. Large ongoing studies of genes involved in the actions of warfarin, together with prospective assessment of environmental factors, will undoubtedly increase the capacity to accurately predict warfarin dose. Implementation of pre-prescription genotyping and individualized warfarin therapy represents an opportunity to minimize the risk of haemorrhage without compromising effectiveness.

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Home prothrombin time monitoring: A literature analysis

Cited by 34 publications

References 69 publications

Is patient self-testing a good thing?

Is patient self-testing a good thing?

Patients' perspectives on self-testing of oral anticoagulation therapy: Content analysis of patients' internet blogs

Pharmacogenetics of warfarin: current status and future challenges

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