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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 …