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Self management of oral anticoagulation: randomised trial

Self management of oral anticoagulation: randomised trial
Self management of oral anticoagulation: randomised trial
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 (2(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.
0959-8138
1057-1059
Fitzmaurice, D.A.
765c89e3-8d55-4dea-a9de-980169a56d40
Murray, E.T.
17303905-7cbf-4f8d-ac9c-c1610ddab51b
McCahon, D.
576bf366-4986-4d25-a740-340c723f6d08
Holder, R.
0af92b79-7fd3-42f6-b211-2e9f0b68607e
Raftery, J.P.
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Hussain, S.
ff6f81c2-7f8a-44bf-9e3c-0d8d540c62d1
Sandhar, H.
bfd1f688-eb6c-4510-bc7c-64b193d22d73
Hobbs, F.D.R.
ed141f5b-6bb8-49d5-ba3f-833ff8176556
Fitzmaurice, D.A.
765c89e3-8d55-4dea-a9de-980169a56d40
Murray, E.T.
17303905-7cbf-4f8d-ac9c-c1610ddab51b
McCahon, D.
576bf366-4986-4d25-a740-340c723f6d08
Holder, R.
0af92b79-7fd3-42f6-b211-2e9f0b68607e
Raftery, J.P.
27c2661d-6c4f-448a-bf36-9a89ec72bd6b
Hussain, S.
ff6f81c2-7f8a-44bf-9e3c-0d8d540c62d1
Sandhar, H.
bfd1f688-eb6c-4510-bc7c-64b193d22d73
Hobbs, F.D.R.
ed141f5b-6bb8-49d5-ba3f-833ff8176556

Fitzmaurice, D.A., Murray, E.T., McCahon, D., Holder, R., Raftery, J.P., Hussain, S., Sandhar, H. and Hobbs, F.D.R. (2005) Self management of oral anticoagulation: randomised trial. BMJ, 331 (7524), 1057-1059. (doi:10.1136/bmj.38618.580903.AE).

Record type: Article

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 (2(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.

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Published date: 2005

Identifiers

Local EPrints ID: 24333
URI: http://eprints.soton.ac.uk/id/eprint/24333
ISSN: 0959-8138
PURE UUID: 53b81336-efd0-4604-b26f-ea35f468a4db

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Date deposited: 30 Mar 2006
Last modified: 07 Jan 2022 22:13

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Contributors

Author: D.A. Fitzmaurice
Author: E.T. Murray
Author: D. McCahon
Author: R. Holder
Author: J.P. Raftery
Author: S. Hussain
Author: H. Sandhar
Author: F.D.R. Hobbs

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