Patient self‐testing and self‐management of oral anticoagulation with vitamin K antagonists: guidance from the British Committee for Standards in Haematology

Predictors of anticoagulation quality in 15 834 patients performing patient self‐management of oral anticoagulation with vitamin K antagonists in real‐life practice: a survey of the International Self‐Monitoring Association of Orally Anticoagulated Patients

“…Moreover, the quality of anticoagulation is considerably influenced by the treatment setting, with higher TIR achieved in anticoagulation clinics or PSM schemes (van Walraven et al, 2006). A number of PSM programmes have been developed and a large number of patients were trained, predominantly in Europe (Cromheecke et al, 2000;Kortke et al, 2001;Sunderji et al, 2004;Fitzmaurice et al, 2005a;Menendez-Jandula et al, 2005;Christensen et al, 2006;Siebenhofer et al, 2008;Jennings et al, 2014;Nagler et al, 2014). PSM training enables patients to self-care with regard to long-term anticoagulation treatment in terms of INR measurements and VKA dosing adjustments.…”

“…Both treatment schemes are summarised under the term 'self-monitoring'. Moreover, PSM was shown to be cost-effective compared to standard care (Gerkens et al, 2012;Sharma et al, 2015;Ferguson et al, 2016) and a number of scientific societies recommended PSM for eligible patients requiring long-term anticoagulation treatment (Ansell et al, 2005;Ageno et al, 2012;Witt, 2012;Jennings et al, 2014). Efficacy and safety in comparison to standard care was established in a number of randomized clinical trials, and data were pooled in several meta-analyses (Garcia- Alamino et al, 2010;Bloomfield et al, 2011;Heneghan et al, 2012;Sharma et al, 2015).…”

“…Both treatment schemes are summarised under the term 'self-monitoring'. A number of PSM programmes have been developed and a large number of patients were trained, predominantly in Europe (Cromheecke et al, 2000;Kortke et al, 2001;Sunderji et al, 2004;Fitzmaurice et al, 2005a;Menendez-Jandula et al, 2005;Christensen et al, 2006;Siebenhofer et al, 2008;Jennings et al, 2014;Nagler et al, 2014). Efficacy and safety in comparison to standard care was established in a number of randomized clinical trials, and data were pooled in several meta-analyses (Garcia- Alamino et al, 2010;Bloomfield et al, 2011;Heneghan et al, 2012;Sharma et al, 2015).…”

“…In addition, life expectancy was estimated to be comparable to the standard population in patients with mechanical heart valve (Mokhles et al, 2011). Moreover, PSM was shown to be cost-effective compared to standard care (Gerkens et al, 2012;Sharma et al, 2015;Ferguson et al, 2016) and a number of scientific societies recommended PSM for eligible patients requiring long-term anticoagulation treatment (Ansell et al, 2005;Ageno et al, 2012;Witt, 2012;Jennings et al, 2014). However, the uptake of PSM is slow (Ferguson et al, 2016) and several reports suggest that the most important question is still open: Which patient is most likely to benefit from PSM (Kyrle & Eichinger, 2012;Li Wan Po, 2012)?…”

Cochrane corner: self-monitoring and self-management of oral anticoagulation

“…In contrast, several barriers to increased uptake of self-monitoring have been identified in the UK,10 despite being advocated by the National Institute for Health and Care Excellence 2. In some instances, point-of-care devices have proved to be inaccurate,11 and therefore, it is essential that patients are regularly reviewed with external quality assurance undertaken 12. Furthermore, for widespread uptake, there is a need to further evaluate the training packages on offer, as many patients seemingly start testing with minimal input from health services 13…”