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

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.