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Ann Thorac Surg 2001;72:1523-1527
© 2001 The Society of Thoracic Surgeons

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Original article: cardiovascular

Self-managed anticoagulation: results from a two-year prospective randomized trial with heart valve patients

^a Department of Cardiac Surgery, Royal Hospitals Trust, Belfast, Northern Ireland, United Kingdom

Accepted for publication June 22, 2001.

* Address reprint requests to Mr O’Kane, Department of Cardiac Surgery, Royal Hospitals Trust, Grosvenor Rd, Belfast, Northern Ireland BT12 6BA, UK
e-mail: hugh{at}doctors.org.uk

Background. This study was conducted to assess the ability of patients receiving heart valve replacements to practice self-managed anticoagulation using a portable coagulometer.

Methods. We carried out a prospective, randomized trial, comparing self-managed anticoagulation with conventional management. Patients practicing self-managed anticoagulation (51 patients) did so at home, measuring their international normalized ratio and then deciding on their dosage of warfarin, while conventionally controlled patients (n = 49) attended hospital clinics or were managed by their family physicians.

Results. We successfully trained 41 of 44 patients who agreed to self-manage their anticoagulant therapy; 34 of the 41 managed their own anticoagulation at home for 2 years. Their control, assessed by a number of tests in range (67.6% versus 58.0%) and time in therapeutic range (76.5% versus 63.8%), was significantly better than that for the group managed conventionally (p < 0.0001). There was no significant difference in mortality or morbidity between the two groups.

Conclusions. Self-managed anticoagulation is a reliable, easily learned method of controlling anticoagulation, and it is suitable for approximately two thirds of patients, with excellent results.

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