Self-management of oral anticoagulation with low- or conventional-intensity INR did not differ for thromboembolism prevention

Abstract Background Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of complications associated with oral anticoagulation therapy. Aim: To evaluate the relationship between health literacy and health and treatment outcomes (concordance with oral anticoagulants, Normalized Ratio control and occurrence of complications) in patients with cardiovascular pathology. Methods Observational, analytic and cross-sectional study carried out on 252 patients with cardiovascular pathology (atrial fibrillation, flutter or valve prosthesis), aged 50–85 years, accessing primary care services in Valencia (Spain) in 2018–2019. Variables referring to anticoagulant treatment with vitamin K antagonists (years of treatment, adequate control, polypharmacy and occurrence of complications, among others) and health literacy (Health Literacy Questionnaire) were analysed. Results All dimensions of health literacy were significantly related to the level of education (p < 0.02), social class (p < 0.02), an adequate control of acenocoumarol (p < 0.001), frequentation of health services (p < 0.001), information by patients to health professionals about anticoagulant treatment (p < 0.03), emergency care visits (p < 0.001) and unscheduled hospital admissions (p < 0.001). Conclusion Health literacy has a relevant influence on the adequate self-management of anticoagulation treatment and the frequency of complications. The different dimensions that comprise health literacy play an important role, but the “social health support” dimension seems to be essential for such optimal self-management. Trial registration ACC-ACE-2016-01. Registration date: December 2015.

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

Heart ◽

10.1136/heartjnl-2015-309123 ◽

2017 ◽

Vol 103 (12) ◽

pp. 895-896 ◽

Cited By ~ 2

Author(s):

Carl J Heneghan ◽

Elizabeth A Spencer ◽

Kamal R Mahtani

Keyword(s):

Oral Anticoagulation ◽

Self Management ◽

Self Monitoring

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Self-management of oral anticoagulation in the elderly: Rationale, design, baselines and oral anticoagulation control after one year of follow-up

Thrombosis and Haemostasis ◽

10.1160/th06-08-0482 ◽

2007 ◽

Vol 97 (03) ◽

pp. 408-416 ◽

Cited By ~ 20

Author(s):

Ivo Rakovac ◽

Caroline Kleespies ◽

Brigitte Piso ◽

Ulrike Didjurgeit ◽

Andrea Siebenhofer

Keyword(s):

Elderly Patients ◽

Oral Anticoagulation ◽

Controlled Trial ◽

Training Programme ◽

Self Management ◽

Target Range ◽

Care Group ◽

Bleeding Events ◽

Anticoagulation Control

SummarySelf-management is safe and reliable in patients with long-term oral anticoagulation (OAC). However, no study has yet assessed the safety and efficacy of OAC self-management in elderly patients with major thromboembolic and haemorrhagic complications as primary outcomes. In this multi-centre, open, randomised controlled trial, patients aged 60 years or more were randomised into the self-management group (SMG) (N=99) or routine care group (RCG) (N=96). We describe the rationale, design, baseline characteristics and interim analyses of oral anticoagulation control quality within the first year of follow-up. The medians of the squared international normalised ratio (INR) value deviations after six and 12 months were significantly lower in the SMG with medians of 0.16 and 0.16 compared to the RCG with medians of 0.25 and 0.25. The percentage of time within target range and the percentage of INR measurements within target range were significantly higher in the SMG versus the RCG within the first six months (medians 71% vs. 58% and 69% vs. 57%), and during the second six months of the study (75% vs. 67% and 72% vs. 57%). The numbers of all thromboembolic events requiring hospitalisation, major bleeding events, and deaths were similar in both groups. These preliminary results suggest that self-management of oral anticoagulation is safe and feasible for elderly patients willing to participate in a structured training programme.

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Self Management of Oral Anticoagulation with the INRatio System: Accuracy and Reliability Following a Two-Day Structured Training Program

Laboratory Medicine ◽

10.1309/jgxchjn1bq71qa40 ◽

2004 ◽

Vol 35 (5) ◽

pp. 303-307

Author(s):

Uwe Taborski ◽

Heinz Völler ◽

Heinrich Körtke ◽

Judith Blunt ◽

Karl Wegscheider

Keyword(s):

Training Program ◽

Oral Anticoagulation ◽

Self Management

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Self-management of oral anticoagulation in children with congenital heart disease

Cardiology in the Young ◽

10.1017/s1047951101000282 ◽

2001 ◽

Vol 11 (3) ◽

pp. 269-276 ◽

Cited By ~ 20

Author(s):

Thomas D. Christensen ◽

Jørn Attermann ◽

Vibeke E. Hjortdal ◽

Marianne Maegaard ◽

J. Michael Hasenkam

Keyword(s):

Cardiac Disease ◽

Oral Anticoagulation ◽

Congenital Heart ◽

International Normalized Ratio ◽

Self Management ◽

Bleeding Complications ◽

Conventional Management ◽

Quality Of Treatment ◽

Congenital Cardiac Disease

Objective: The concept of self – management of oral anticoagulation has been shown to entail better quality of treatment than conventional management when assessed in selected adults. We have extended the concept of self – management to include children with congenital cardiac disease, hypothesizing self-management of oral anticoagulation is also possible in this subset of patients. Our aim was to assess the quality of self-management. Methods: We trained 14 children aged from 2.2 to 15.6 years, with a mean age of 9.7 years, and their parents, in domiciliary analysis of the International Normalized Ratio and necessary adjustment of dosage of coumarin. The curriculum for training lasted for 27 weeks, and the patients and their parents were followed for a period of up to 31 months by weekly measurement of the values obtained for the International Normalized Ratio. Results: The patients were observed over a mean of 547 days, with a range from 214 to 953 days. The patients were within the therapeutic targetted range of the International Normalized Ratio for a median of 65.5% of the time, with a range from 17.6 % to 90.4 %. None of the patients experienced thromboembolic or bleeding complications requiring doctoral intervention. All the patients and their parents expressed full satisfaction with the treatment. Conclusion: Selfmanagement of oral anticoagulation provides a good quality of treatment, which is feasible and safe in selected children with congenital cardiac disease.

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