Optimization of long term control of oral anticoagulation by patient self-management

Morbidity and mortality of patients with lifelong oral anticoagulant therapy are influenced by the complications of thromboembolism and bleeding These complications are mainly caused by inadequate control of oral anticoagulant therapy in primary medical care. in routine medical care only 30-60% of prothrombin times are within the therapeutic target range. Thus, the frequency of severe complications is significantly higher with routine medical care (10,9-16,2% per patient year of therapy) as compared to care in specialized anticoagulation clinics (2,4-2,8%). Self-management of oral anticoagulant therapy has been introduced in clinical practice 10 years ago. After a structured leaching program most patients are able to control their prothrombin limes (PT) and adjust oral anticoagulant therapy Self-management results ii, improved accuracy of oral anticoagulant therapy with more than 80-90% of PT times in the therapeutic target range. In two prospective randomized studies the incidence of severe bleeding and thromboembolism was significantly reduced by self-management in comparison to routine medical care. Furthermore, ii is estimated that with self-management of oral anticoagulant? therapy substantial cost savings can be achieved through prevention of major bleeding and thromboembolism. Finally self-management results in improved treatment related quality-of-life-measures.