Patient management of anticoagulants cuts deaths

Self-management of dosing for oral anticoagulation drugs such as warfarin reduces deaths and thromboembolic events, US research suggests.

Anticoagulants better managed (Photograph: Jim Varney / Science Photo Library)
Anticoagulants better managed (Photograph: Jim Varney / Science Photo Library)

A team from the Minneapolis Veterans Affairs Health Care System, Minnesota, found management of vitamin K antagonist treatment was better with patient self adjustment than standard clinical care.

This approach did not increase the risk of serious bleeding events, the researchers found.

Devices are available that allow patients to measure their levels and adjust dosing accordingly.

Such devices reduce the number of appointments needed to adjust doses of oral anticoagulants for patients who are at risk of thromboembolic complications.

Researchers assessed 22 randomised controlled trials published between 1966 and 2010. They found that self-monitoring or self-adjustment resulted in better patient outcomes compared with clinical care. Self-care patients had a 26% lower risk for death and a 42% reduction in major thromboembolism.

Researchers said patients who were older and more ill tended to withdraw from such studies. They suggested that this approach should be reserved for highly motivated patients.

The researchers said studies would now need to examine whether such care could be cost-effectively implemented into typical healthcare settings.

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Annals of Internal Medicine

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