CMAJ • March 13, 2007; 176 (6). doi:10.1503/cmaj.1060152.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Self-managed oral anticoagulation therapy

Jeevan P. Marasinghe* and A.A.W. Amarasinghe{dagger}

Registrar in Obstetrics and Gynecology, Teaching Hospital, Peradeniya, Sri Lanka;* Psychiatrist, McDonough, Ga.{dagger}

Dean Regier and colleagues successfully demonstrated that there are fewer thrombotic events, fewer major hemorrhagic events, fewer deaths and substantial cost savings for oral anticoagulation therapy self-managed by the patient compared with the same therapy managed by a physician.1 Several clinical trials have shown patient self-management of oral anticoagulation therapy to be cost-effective, and it reduces the demand for scarce health care resources.2,3

The biggest challenge preventing large-scale adoption of the self-management model is that such models have been shown to be appropriate for only a significant minority of patients.4 Special attention has to be paid to selecting appropriate patients, training them how to adjust dosages and providing clinical supervision. Not all patients have the ability to understand the concept of oral anticoagulation therapy and the risks of overtreatment. Patient self-management might have turned out to be not all that attractive from an economic standpoint if the effort required to select and train patients as well as product maintenance had been factored into the analysis conducted by Regier and colleagues. The generalizability of their results to a broader population and the cost-effectiveness of this program remain to be demonstrated.

REFERENCES

  1. Regier DA, Sunderji R, Lynd LD, et al. Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy. CMAJ 2006;174(13):1847-52.[Abstract/Free Full Text]
  2. McCahon D, Fitzmaurice DA, Murray ET, et al. SMART: self-management of anticoagulation, a randomised trial. BMC Fam Pract 2003;4:11.[CrossRef][Medline]
  3. Ansell JE, Patel N, Ostrovosky D, et al. Long-term patient self-management of oral anticoagulation. Arch Intern Med 1995;155(20):2185-9.[Abstract/Free Full Text]
  4. Fitzmaurice DA, Gardiner C, Kitchen S, et al. An evidence-based review and guidelines for patient self-testing and management of oral anticoagulation. Br J Haematol 2003;131:156-165.




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