Anticoagulation Patient Self-monitoring in the United States

Considerations for Clinical Practice Adoption

Edith A. Nutescu, Pharm.D.; Sacheeta Bathija, B.Pharm.; Lisa K. Sharp, Ph.D.; Ben S. Gerber, M.D., M.P.H.; Glen T. Schumock, Pharm.D., M.B.A.; Marian L. Fitzgibbon, Ph.D.

Disclosures

Pharmacotherapy. 2011;31(12):1161-1174. 

In This Article

Patient Selection

Although the benefits of patient self-monitoring (PST and/or PSM) are high, this method of management is not yet an option for every patient receiving oral anticoagulation therapy. It is important to note that in most of the studies, less than 50% of the patients met enrollment for PST or PSM because of stringent eligibility and training criteria.[35,36] However, the THINRS study showed that 80% of trained patients demonstrated competency,[67] although the criteria for calculating competency differed from earlier studies, as the authors only used patients who met enrollment criteria and did not use the total number of patients screened in their calculations. In most of the studies, patients had to meet criteria for manual dexterity, visual acuity, and mental status, and have the confidence and ability to perform PST or PSM.[35,36] In addition, patients (or caregivers) deemed candidates for PST or PSM need to understand the potential risks of anticoagulation therapy. More information is needed to determine the influence of factors such as education level or social status as determinants for competency and successful adoption of PST or PSM by patients with less than a 12th grade education and those of lower sociodemographic status.

Self-monitoring is suitable in patients receiving long-term oral anticoagulation who are willing to participate in their own care and have adequate confidence, visual acuity, manual dexterity, and mental ability to perform the testing and maneuver the point-of-care device. Patients must be willing to accept the responsibility of self-care, complete a structured training course, and show competence in self-monitoring.[33,34] If patients are interested but unable to perform PST or PSM themselves, family members or a caregiver can undertake this for them. Medical oversight should be maintained on a continuous basis with the patient's anticoagulation provider to ensure safety of therapy. Patients who have access or time barriers to coming to a clinic or laboratory, those who travel, and those who have difficulty with scheduled appointments may particularly benefit from this method of care.[3]

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