Cohort study of Anticoagulation Self-Monitoring (CASM): a prospective study of its effectiveness in the community.
Authors
Ward, Alison
Tompson, Alice
Fitzmaurice, David
Perera, Rafael
Heneghan, Carl
Publication Date
2015-07Journal Title
Br J Gen Pract
ISSN
0960-1643
Publisher
Royal College of General Practitioners
Volume
65
Issue
636
Pages
e428-e437
Language
eng
Type
Article
This Version
VoR
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Ward, A., Tompson, A., Fitzmaurice, D., Sutton, S., Perera, R., & Heneghan, C. (2015). Cohort study of Anticoagulation Self-Monitoring (CASM): a prospective study of its effectiveness in the community.. Br J Gen Pract, 65 (636), e428-e437. https://doi.org/10.3399/bjgp15X685633
Abstract
BACKGROUND: Trials show that oral anticoagulation therapy (OAT) substantially reduces thromboembolic events without an increase in major haemorrhagic events, but it is not known whether these results translate into routine practice. AIM: To estimate the current levels of control and adverse events in patients self-monitoring OAT, explore the factors that predict success, and determine whether the level of side effects reported from randomised controlled trials are translated to a non-selected population. DESIGN AND SETTING: Prospective cohort study in the UK. METHOD: Participants were aged ≥18 years and registered with a GP. Main outcomes were the proportion of participants, over 12 months, who were still self-monitoring, had not experienced adverse events, and had achieved >80% of time in therapeutic range (TTR). RESULTS: In total, 296 participants were recruited; their median age was 61 years and 55.1% were male. Participants were predominately professional or held a university qualification (82.7%). At 12 months, 267 (90.2%) were still self-monitoring. Mean TTR was 75.3% (standard deviation 16.9).Six serious and two minor adverse events were reported by GPs. Only 45.9% of participants received any in-person training at the outset. Increased age (P = 0.027), general wellbeing (EQ-5D visual score, P = 0.020), and lower target international normalised range (INR, P = 0.032) were all associated with high (>80% TTR) levels of control. CONCLUSION: The findings show that, even with little training, people on OAT can successfully self-monitor, and even self-manage, their INR. TTR was shown to improve with age. However, widespread use of self-monitoring of INR may be limited by the initial costs, as well as a lack of training and support at the outset.
Keywords
Humans, Thromboembolism, Hemorrhage, Warfarin, Anticoagulants, Drug Monitoring, International Normalized Ratio, Prognosis, Self Administration, Aftercare, Administration, Oral, Prospective Studies, Equipment Design, Blood Coagulation, Dose-Response Relationship, Drug, Aged, Middle Aged, Patient Satisfaction, Primary Health Care, Female, Male, United Kingdom
Embargo Lift Date
2100-01-01
Identifiers
External DOI: https://doi.org/10.3399/bjgp15X685633
This record's URL: https://www.repository.cam.ac.uk/handle/1810/277280
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