Thrombosis and Haemostasis
Author Interview
Coagulation and Fibrinolysis
Dhippayom et al.
Thromb Haemost
DOI: 10.1055/a-1677-9608
T&H
What are the main conclusions?
TEERAPON DHIPPAYOM:
Patient self-care by measuring the INR value at least once weekly has been shown to be more effective in controlling INR level than usual care and less frequently measured INR. The intensity of INR measures and provider were found to have influential effects on the outcomes and should be considered when evaluating the effect of warfarin self-care intervention.
T&H
What are the paper's implications?- to the public?-to medical professionals?
TEERAPON DHIPPAYOM:
Patients who undertake warfarin self-care management, either patient self-test (PST) or patient self-management (PSM), should measure their INR value at least once a week or more often to achieve optimal anticoagulation control. If PST is deemed more suitable to a particular patient than PSM, we suggest e-Health should be considered over a direct contact with healthcare practitioners (HCP) to advice the patient on warfarin dosage adjustment. This is because both platforms were not significantly different, but the use of e-Health would help to reduce the burden of HCP.
T&H
Are the findings clinically significant? Should the findings change practice?
TEERAPON DHIPPAYOM:
The effects on clinical outcomes (thromboembolic events, major bleeding, and all-cause mortality) were not significant or accompanied with very low certainty of evidence. Further large-scale clinical trials are required to provide supportive evidence on clinical outcomes. However, based on the moderate certainty of evidence on anticoagulation control, we think that clinicians and guideline developers should consider recommending patients who undertake warfarin self-care management to measure their INR value at least once a week or more often to achieve optimal anticoagulation control.
