Medical Information: Benefits of Coagulation Self-Monitoring

The CoaguChek family of instruments helps both you and your patient to benefit from Coagulation Self-Testing.

Clinical benefits

Studies show that INR/Quick Self-Monitoring makes oral anticoagulation more effective, with positive results such as:

• Less complications: reduction of thromboembolic and major bleeding events (1-3)
  
• Reduction in the number and duration of periods spent in hospital (4)
  
• No dependence on country and manufacturer-specific reagents
  
• Greater safety when living conditions change (5)
  
• Significant increase in the number of INR results within the therapeutic range and thus better therapy adjustment and fewer INR fluctuations (3)
  
• Proven long-term cost-benefit effectivity for the healthcare system (6, 7)

There is a direct connection between the time in which INR is within the therapeutic corridor and the avoidance of complications, which is the targeted health outcome: 30% increase in time within therapeutic range produces as much as 76% decrease in major events rates (8).

The rate of complications, such as incidences of haemorrhages or thromboembolism, is dramatically reduced.

Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998; 158:1641-1647.

Routine management

Anticoagulation clinic

Patient Self-Management

Benefits for the Healthcare Professional

• INR is measured with just a drop of capillary blood, results are discussed and the necessary measures introduced
  
• All in a single consultation: there is no time lost sending in samples and waiting for the results. Fewer consultations are necessary and administration overheads are reduced
  
• The patient feels he/she is being competently supervised, leading to better compliance and a trusting doctor-patient relationship
  
• Self-Monitoring is always done with the same coagulometer. Also, the result can be directly compared with earlier results, changes show up immediately, and therapy can be adjusted with immediate effect
  

Benefits for the Patient

The benefits of Patient Self-Management and Patient Self-Monitoring are well documented, as shown by many patients' comments and numerous clinical studies:

• Significant improvement of quality of life. Patients gain more independence, e.g. they do not need to apply for days-off, and travelling is much easier (9, 10)
  
• The patient feels more involved in managing his/her condition, leading to better compliance (11)
  
• Less blood is needed compared to venous sampling. Just one drop is enough!
  

Approaches for Self-Testing

Two approaches can be observed for patients in Coagulation Self-Testing:

• Patient Self-Monitoring: Here the patient simply assumes the job of measuring INR, while the dosing decision is up to the treating physician
  
• Patient Self-Management: After being suitably trained the patient assumes responsibility for monitoring anticoagulation as well as for adjusting the dose of anticoagulant based on the reading (preferably INR)

Most patients or their relatives can be taught to self-monitor their anticoagulation and to adjust their medication accordingly whenever they wander from their therapeutic corridor (5).

Important: Patients all the time should stay in close contact to the Healthcare Professional.

Testing frequency

The recommended testing frequency during Self-Monitoring is once a week but a lower frequency of testing can be justified based on institutional or patient conditions (5).

Greater security for patients undergoing anticoagulation therapy by means of more frequent testing

CoaguChek® - Confidence is the key to therapy success

The CoaguChek family of instruments, based on Roche's long experience in the field of Coagulation Monitoring, can help you and your patients get a good alternative to traditional testing.

Statements based on references

1. Sawicki PT, Glaser B, Kleespies C, et al. Self-management of oral anticoagulation: long-term results. J Intern Med 2003; 254:515-516.
   
2. Menendez-Jandula B, Souto JC, Oliver A, et al. Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med 2005; 142:1-10.
   
3. Koertke H, Minami K, Boethig D, et al. INR self-management permits lower anticoagulation levels after mechanical heart valve replacement. Circulation 2003; 108 Suppl 1:II75-78.
   
4. Koertke H, Minami K, Bairaktaris A, Wagner O, Koerfer R. INR self-management following mechanical heart valve replacement. J Thromb Thrombolysis 2000; 9 Suppl 1:S41-45.
   
5. Ansell J, Jacobson A, Levy J, Voller H, Hasenkam JM. Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation. International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation. Int J Cardiol 2005; 99:37-45.
   
6. Anderson DR, Harrison L, Hirsh J. Evaluation of a portable prothrombin time monitor for home use by patients who require long-term oral anticoagulant therapy. Arch Intern Med 1993; 153:1441-1447.
   
7. Taborski U, Wittstamm FJ, Bernardo A. Cost-effectiveness of self-managed anticoagulant therapy in Germany. Semin Thromb Hemost 1999; 25:103-107.
   
8. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998; 158:1641-1647.
   
9. Cromheecke ME, Levi M, Colly LP, et al. Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomised cross-over comparison. Lancet 2000; 356:97-102.
   
10. Sawicki PT. A structured teaching and self-management program for patients receiving oral anticoagulation: a randomized controlled trial. Working Group for the Study of Patient Self-Management of Oral Anticoagulation. Jama 1999; 281:145-150.
    
11. Diehm C. [Self-management of anticoagulation therapy] (german article). MMW
    
12. Fortschr Med 2005; 147:34-36.

Please do not hesitate to contact your local Roche representative if you need further information or references.