0
Letters |

Patient Self-management of Oral Anticoagulation—Reply

Peter T. Sawicki, MD, PhD
JAMA. 1999;281(24):2283-2284. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-24-jbk0623.
Text Size: A A A
Published online

Extract

In Reply: Drs Li and Tosiello point out that a teaching program for patients receiving oral anticoagulation without INR self-monitoring and patients' self-adjustment of coumarin dosage may also improve treatment results. To our knowledge, there are no trials comparing the effect of education programs with and without self-management of anticoagulation. However, in diabetic patients it has been clearly shown that education programs will not lead to an improvement in blood glucose control unless adequate training in blood glucose self-monitoring and self-adjustment of insulin treatment is also included.1 Of greatest importance, in our study the major improvement in quality of life was closely linked to patients' ability to self-monitor and self-manage treatment. The objective of our study was to investigate the effect of patients' self-management of oral anticoagulation. Of course, self-management of anticoagulation therapy can only be safely performed if it is combined with extensive information and effective patient training. Therefore, to investigate the effect of self-management of anticoagulation on the quality of anticoagulant therapy, we had to include an appropriate patients' education program. Our program does not include fixed algorithms for the adjustment of the coumarin dosage. The optimal coumarin dosage adjustment differs greatly from patient to patient. Therefore, instead of teaching fixed algorithms, several examples of dosage adjustment were discussed with the patients. Thus, the patients were encouraged to find their own best individual method of dosage adjustment based on self-monitoring. There is a lack of valid data on the effects of using algorithms in the management of anticoagulation. However, in insulin-treated diabetic patients, fixed algorithms, or so-called sliding scales, have shown to provide no benefit or have even proved to be harmful.2

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();