Post-conference session: Experience with patient self-management of oral anticoagulation

Abstract

Long-term oral anticoagulation requires careful patient monitoring in order to optimize results and to limit hemorrhagic or thromboembolic complications of treatment. For this reason, any improvement in anticoagulant control and management can be expected to have far-reaching conse- quences in extending longevity and decreasing complications in anticoagulated patients after heart valve surgery. Because one attractive means of improving anticoagulant manage- ment is to give patients a share of the responsibility, a pro- gram was designed to encourage patients to take an active role in monitoring their own prothrombin time (PT) and managing their own oral anticoagulation. During the period from August 1986 to February 1992, 600 patients requiring long-term anticoagulation, mainly after heart valve replace- ment, were trained to measure their own PT at the Cardiac Rehabilitation Center (Herz-Krauslauf-Klinik, Bad Berle- burg, Germany) and to manage their own therapy: 216 pa- tients could be followed with regard to their self-determined prothrombin times. The results were within the target range in 83.1% of the PT determinations (n -- 12,306 measure- ments) taken by the patients themselves. Neither major bleeding nor thromboembolic complications were observed in 205 patient-years of self-monitoring of PT and self- management of oral anticoagulation. Key