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Apr 12, 2011

Could Self-management of Anticoagulation Doses be Safer than Traditional Methods?

Home devices help patients manage medication and prevent blood clots.

It is estimated that over 5% of persons ages 65 to 74 and more than 10% of persons over 75 years receive long term oral anticoagulants to help prevent the formation of blood clots in the veins, known as thromboembolism. Thromboembolism is a serious complication that can occur in high risk patients, which can be life threatening. Therefore, patients considered at risk for this condition are often prescribed long-term anticoagulation with vitamin K antagonists used to help thin the blood and prevent clots from forming. However, those undergoing this treatment require close monitoring, as too much anticoagulant can make the blood too thin, increasing risk for bleeding, while too little can increase risk for thromboembolism. As a result, patients on long-term anticoagulants require frequent testing and dose adjustments at clinics, which can unfortunately prove costly and inconvenient for both patients and healthcare providers.

To help address this issue and improve quality of life for patients receiving long-term anticoagulantion, providers have recently begun to offer more convenient options for the monitoring of treatment, significantly increasing patient autonomy. For those who qualify, patients can purchase home devices for self-testing and can even learn how to adjust their own anticoagulation doses, known as patient self-management. While patient self-testing (PST) and patient self-management (PSM) are not for everyone, they can provide a great alternative to the frequent clinic and lab visits that long-term anticoagulation treatment often entails for high-risk patients.

But while PST and PSM seem convenient, many wonder if they are safe options for patients. Surprisingly, a recent study published in the Annals of Internal Medicine actually suggested that PST and PSM may be safer than traditional monitoring through clinics. Both PST and PSM demonstrated lower mortality rates and lower risk for thromboembolism, with no increased risk for bleeding, in comparison with usual care. Patients using home testing and monitoring also reported significantly higher patient satisfaction and quality of life.

While additional research is necessary to support these findings, results are encouraging. With auxiliary data, the use of home testing and monitoring could significantly increase in patients undergoing long-term anticoagulation, not only improving quality of life for patients but also improving outcomes. 

Questions for You to Consider

  • Who is eligible for patient self-testing and patient self-management?

  • PST and PSM are most appropriate for motivated patients who are committed to this process, and also have the mental and physical capacity to successfully test and manage their anticoagulation treatment. If you think that you might be eligible, ask your doctor if PST or PSM might be right for you.
  • Is home testing more expensive than usual care?

  • Testing devices are available with a prescription and cost between $1,500 and $2,000, with testing strips ranging from $7-12 each. Medicare covers these costs for many qualifying patients, as do many other insurance companies. Over time, PST and PSM can actually help save both patients and health providers money, by decreasing clinic and lab visits and more successfully managing anticoagulation treatments.

  • Is self-testing and self-management difficult?

  • While PST and PSM are not right for everyone, patients that qualify undergo intensive training sessions until they are comfortable with self-testing and dose adjustment. Responsibilities are often gradually transferred from the physician to the patient, and 24-hour help-lines are usually available for patients with any questions or concerns.