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Therapeutics
Self management of long term oral anticoagulation was as effective as specialist anticoagulation clinic management

https://doi.org/10.1136/ebm.6.2.41

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    (2000) Lancet 356, 97. Cromheecke ME, Levi M, Colly LP, et al.. Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomised cross-over comparison.. Jul 8;. :. –102.
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 QUESTION: In patients needing long term oral anticoagulation treatment, is self management as effective as specialist anticoagulation clinic management?

    Design

    6 month, randomised {allocation concealed*}†, controlled crossover trial with blinded outcome assessments (patients and clinicians)*.

    Setting

    Anticoagulation clinic in the Netherlands.

    Patients

    50 self supporting patients (mean age 42 y, 59% men) who were receiving long term anticoagulation treatment with oral agents. 49 patients (98%) completed the study.

    Intervention

    Self managed care involved education about the principles and monitoring of treatment. Live and video instructions were given on how to use a capillary fingerstick and automated device for self measurement. Patients were then instructed about dose adjustments of oral anticoagulants by using a standard nomogram. Anticoagulation clinic management included measurements and dosing done at the clinic. After 3 months, patients crossed …

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    Footnotes

    • Source of funding: In part, Roche Diagnostics (monitors and test strips).

    • For correspondence: Dr M Levi, Department of Vascular Medicine/Internal Medicine, Academic Medical Centre F-4, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Fax +31 20 691 9658.

    • ↵* See glossary.

    • ↵† Information provided by author.

    • ↵‡ CI calculated from data in article.