Patient self-management of oral anticoagulation guided by capillary (fingerstick) whole blood prothrombin times

Article Abstract:

Oral anticoagulant therapy requires constant management of the level of the anticoagulant, because the risk of serious hemorrhage is high, affecting approximately five percent of all patients. The ability of patients to monitor and adjust their own anticoagulant therapy is discussed. An instrument to measure the time required for blood to clot, known as the prothrombin time (PT), and the effective level of anticoagulant can be used by patients to adjust their levels of anticoagulant. The device is hand-held and battery- driven and uses a small portable laser to perform the measurement. The device allows accurate and virtually instantaneous assessments of PT. The system was evaluated by a group of 16 patients who were under anticoagulant therapy with the drug warfarin during an average period of 43 weeks. During that time, 458 measurements of PT were obtained with the device, and in 393 measurements the level of warfarin was found to be appropriate. In the 65 readings that were outside of the acceptable range, the patients made the correct adjustment 75 percent of the time. When adjustment mistakes were made by the patients, they were minor and, because warfarin levels only adjust slowly, not dangerous. Analysis of the reasons for the mistakes reveals that they stemmed from a lack of understanding of proper levels. This pilot study demonstrates that more responsibility for the maintenance of effective anticoagulant drug titer can be borne by the patient.

Research, Blood clotting, Blood coagulation, Self-care, Health, Self care (Health)

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Influence of low-intensity warfarin treatment on patients' perceptions of quality of life

Article Abstract:

Warfarin is a drug that interferes with blood clotting, and is prescribed for patients at risk of complications from blood clots, such as strokes. The effectiveness of warfarin is assessed by measuring the prothrombin time; this blood test shows how long a given patient's blood takes to clot relative to that of a control sample. Until recently, it was thought that the prothrombin time needed to be 1.5 to 2.0 times longer than the control for the warfarin to be effective at preventing blood clots, but several new studies have shown that a prothrombin time of 1.3 to 1.5 times the control is sufficient. Physicians have, on occasion, been reluctant to prescribe warfarin because the risk of bleeding complications while taking the drug is high. A perception has existed among both patients and physicians that those who take warfarin experience a decreased quality of life, because of the drug's potential complications as well as the needs to modify activities while taking it (such as avoiding rough contact sports) and have frequent blood tests to monitor the prothrombin time. The physician's view that warfarin therapy is troublesome is likely to affect the patient's view of taking the drug. With the newer low-intensity regimens that have been shown to be useful, both patients and physicians are likely to experience a change in their perceptions of the impact of warfarin on the quality of life. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Editorial

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Low-molecular-weight heparin as bridging anticoagulation during interruption of warfarin: assessment of a standardized periprocedural anticoagulation regimen

Article Abstract:

Canada, Pharmaceutical Preparation Manufacturing, Pharmaceutical preparations, Anticoagulant Preparations, Heparin Preparations, Care and treatment, Usage, Complications and side effects, Thromboembolism, Heparin

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