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Self-managed anticoagulant therapy may benefit patients with heart valves
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Self-management of oral anticoagulant therapy may improve standard care for patients with mechanical heart valves, according to study results.
“Only small studies have evaluated the effectiveness of [patient self-management] in mechanical heart valve patients in clinical practice,” the researchers wrote. “Most of these studies did not include a control group or they used a methodologically problematic comparison. These studies have focused on surrogate variables and not clinical complications, which makes interpretation difficult in terms of clinical benefit.”
Thomas Decker Christensen, MD, PhD, of the department of cardiothoracic and vascular surgery and Institute of Clinical Medicine at Aarhus University Hospital in Denmark, and colleagues enrolled 615 patients with mechanical heart valves and 3,075 matched controls. Controls were matched with patients on sex, date of birth, year of initial valve surgery and grouped valve position.
Prospective patient data were gathered from databases at Aarhus University Hospital or Aalborg University Hospital, both in Denmark. Self-management of oral anticoagulant therapy included attending an educational program on using a coagulometer, interpreting INR values and vitamin K antagonist dosing, and was associated with both hospitals; controls received traditional management. Outcome measurements included major bleeding, thromboembolic events and death.
Lower event rates were observed in the patient self-management group vs. the control group. At 5 years, self-management correlated with a decreased risk for all-cause mortality compared with traditional management (adjusted HR = 0.49; 95% CI, 0.34-0.71). The HRs for thromboembolism and major bleeding in the self-management group were 0.91 (95% CI, 0.66-1.24) and 0.83 (95% CI, 0.56-1.22), respectively.
“Owing to superior clinical effectiveness, self-managed oral anticoagulant therapy may potentially improve the standard of care for patients with mechanical heart valves,” the researchers write. “Self-management of [oral anticoagulant therapy] … is clinically effective and could be considered as the standard of care for these patients.” – by Julia Ernst, MS
Disclosure: Christensen reports financial relationships with AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Roche Diagnostics and Takeda. The study was partially funded by a nonrestricted grant from Takeda Denmark. Please see the full study for a list of all other authors’ relevant financial disclosures.
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