Additional information from the GELIA database: analysis of benefit from self-management of oral anticoagulation (GELIA 6)
Clinic for Cardiothoracic Surgery, University of Basle, Kantonsspital, Basle, Switzerland
* Correspondence: Michael Preiss, MD, Clinic for Cardiothoracic Surgery, University Hospital Basle, Spitalstraße 21, CH-4031 Basle, Switzerland.
Abstract
Aim 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 (TTR), 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.
Key Words: GELIA study • International Normalized Ratio • oral anticoagulation • self-management
References
- Samsa GP, Matchar DB, Goldstein LB, et al. Quality of anticoagulation management among patients with a trial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med. 2000;160:967–973
[Abstract/Free Full Text] - Cromheeke ME, Levi M, Colly LP, et al. Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomized cross-over comparison. Lancet. 2000;356:97–102[CrossRef][Web of Science][Medline]
- Horstkotte D. Optimal frequency of patient monitoring and intensity of oral anticoagulation therapy in valvular heart disease. J Thromb Thrombolysis. 1998;5:19–24
- Samsa GP, Matchar DB. Relationship between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patient self-management. J Thromb Thrombolysis. 2000;3:283–292
- Koertke H, Minami K, Bairaktaris A, Wagner O, Koerfer R. INR self management following mechanical heart valve replacement. J Thromb Thrombolysis. 2000;9:41–45[CrossRef]
- Hasenkam JM, Kimose HH, Knudsen L, et al. Self-management of oral anticoagulant therapy after heart valve replacement. Eur J Cardiothorac Surg. 1997;11:935–942[Abstract]
- Ansell J, Hughes R. Evolving models of warfarin management: anticoagulation clinics, patient self-monitoring, and patient selfmanagement. Am Heart J. 1996;132:1095–1100[CrossRef][Web of Science][Medline]
- Watzke HH, Forberg E, Svolba G, Jimenez E, Krinninger B. A prospective controlled trial comparing weekly self-testing and self-dosing with the standard management of patients on stable oral anticoagulation. Thromb Haemost. 2000;83:661–665[Web of Science][Medline]
- Lafata JE, Martin SA, Kaatz S, Ward RE. Anticoagulation clinics and patient self-testing for patients on chronic warfarin therapy: a cost-effectiveness analysis. J Thromb Thrombolysis. 2000;9:13–19[Web of Science][Medline]
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