Warfarin Self-Monitoring Superior to Clinic Management

	August 18, 1999 - Two researchers presented data today
showing that patients who monitor their own oral Coumadin dose may
do better than those who are managed in a clinic. The research
was given at the 27th International Congress on Thrombosis and
Haemostasis.
	Herbert Watkze compared 49 Austrian patients who were
taught to self-test INR levels and manage their own dosage with
53 patients seen at the university's outpatient anti-coagulation
clinic. INR levels were tested weekly in each group for 3 months.
Self-monitoring patients were told to aim for a specific target
value and were also asked to keep their INR withing a specific
range at all times.
	84% of self-management patients kept their INR within
range, compared to 78% of those seen at the clinic. Self-
monitoring patients came very close to hitting their intended
average INR over one year. For self-monitoring patients with
artificial heart valves, the intended average was 3.2, and after
a year, patients hit an average of 3.15. For clinic-managed
patients with artificial valves, the target was 3.5, and a year
later, the actual average was 3.19. Dr. Watzke concluded that a
self-management protocol is slightly better than conventional
management.
	Dr. M. Cromheecke of the University of Amsterdam, who
also studied Coumadin self-management, reached a more cautious
conclusion. She enrolled 50 patients, most of whom were receiving
Coumadin because of prosthetic heart valves. They were assigned to
either self-management or clinic management for the first 3 months,
and then crossed over to the opposite method.
	Patients spent 58% of the time within their target INR
range while self-managing and 51% of their time within range as
clinic patients. When self-managing, patients had a lower incidence
of serious under- or over-anticoagulation; 3.5% compared with 5.3%
for clinic patients.
	Dr. Cromheecke said that self-management was at least as
effective as clinic management, but she added that longer term
studies are needed.