Benton M. Wheeler, MD
Potential Financial Conflicts of Interest: None disclosed.
Wheeler B.; Patient Self-Management of Oral Anticoagulation. Ann Intern Med. 2005;142:1023. doi: 10.7326/0003-4819-142-12_Part_1-200506210-00015
Download citation file:
Published: Ann Intern Med. 2005;142(12_Part_1):1023.
TO THE EDITOR:
The design of the study by Menéndez-Jándula and colleagues on patient self-management of oral anticoagulant therapy (1) has some important limitations. The authors compared monthly conventional management of anticoagulant therapy with weekly self-management and reported no significant difference in unadjusted percentages of end-range international normalized ratios (INRs). However, this is an unfair comparison.
In my office, prothrombin times are checked every 2 weeks and then weekly if the dose has to be adjusted. Patients who do not require frequent dose adjustments can have this interval increased to 3 or 4 weeks. It would seem more reasonable for Menéndez-Jándula and colleagues to have compared conventional and self-management approaches using the same interval between tests. Furthermore, in my experience, portable INR monitors are not as accurate or as consistent as those used in the laboratory in my hospital. If the real therapeutic range is wider when portable monitors are used, more INR measurements would be within the therapeutic range. In Menéndez-Jándula and colleagues' study, were the INR measurements obtained from the portable monitors repeated in the office so the true accuracy and consistency of the portable monitors could be determined?
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only