State-of-the-art patient self-management for control of oral anticoagulation.

Currently, in Germany, there is a successful program where patients monitor their own coagulation status through self-testing. The advent of a new generation of coagulometers has allowed more and more patients to use self-testing to monitor their coagulation status. The development of a structured training program by the Association of Self-Management of Anticoagulation (ASA), and the effective cost reimbursement system by health insurance companies has furthered the success of this program. The reliability of the coagulometers is quite important to the success of this program, and has been extensively evaluated. These systems are characterized by high accuracy and precision, and low intra-/interassay variation. They also exhibit excellent recovery of the therapeutic range. Several clinical studies have shown that patients performing self-management remain in the therapeutic range a greater percentage of the time when compared to conventional testing, and tended to have less incidences of bleeding or thromboembolic complications. It is estimated that about 50 to 60% of all patients on anticoagulant therapy in Germany are suitable candidates for self-management.