Additional information from the GELIA database: analysis of benefit from self-management of oral anticoagulation (GELIA 6)

Aims Oral anticoagulation can be managed either by a general practitioner or by the patient. The objective of the present analysis was to investigate which form of management is more appropriate for handling oral anticoagulation. Method and results The subgroup of 355 patients in the German Experience in Low Intensity Anticoagulation (GELIA) study who switched during the study from general practitioner management to patient self-management (PSM) comprised the study population. The percentage of International Normalized Ratio measurements within the randomly assigned range was used as an estimator for individual time in target range (TFR), and was measured for each patient during general practitioner management and PSM; patients therefore served as their own controls. Switching from general practitioner management to PSM resulted in a significant benefit (11% greater TTR). Furthermore, with PSM there was a profound tendency toward reduced incidence of serious complications (3(.)28, 95% confidence interval [CI] 2(.)1-4(.)8, versus 4(.)67. 95% CI 2(.)9-7(.)1, per 100 patient-years). Conclusion Clinical outcome was improved with PSM because of the greater TTR. PSM led to more stringent anticoagulation control because of more frequent testing, and was thus equivalent to, if not better than, general practitioner managed anticoagulation. (C) 2001 The European Society of Cardiology.