Self-management of anticoagulation.

Treatment with vitamin K antagonists (i.e., warfarin or coumadin derivatives) requires repeated monitoring of the intensity of anticoagulation and regular dose adjustment. Nevertheless, many patients are not in the therapeutic target range for a considerable proportion (30-50%) of the time. In addition, repeated laboratory checks and visits to the (anticoagulation) clinic or office are time-consuming and may have a negative impact on patient satisfaction. Recently, reliable portable coagulometers have become available and these devices allow the measurement of the international normalized ratio (INR) from a small drop of capillary blood, thereby enabling patients to self-manage their anticoagulation. Clinical studies show that self-testing of the INR and self-adjusting of the warfarin dose results in a better control of anticoagulation in comparison with regular care by general practitioners or specialists and is at least as good as management by a specialized anticoagulation clinic. Moreover, treatment-related patient satisfaction and quality of life improves in patients performing self-management of anticoagulation.