Original article: cardiovascularSelf-managed anticoagulation: results from a two-year prospective randomized trial with heart valve patients
Section snippets
Material and methods
The Coaguchek is a portable coagulometer that uses a test strip containing a reaction chamber coated with iron oxide particles and thromboplastin derived from rabbit brain. A drop of capillary blood (10 to 25 μL) obtained from a finger prick is applied to the strip, which is in an electromagnetic field. As the blood clots, the iron oxide particles, previously agitated by the electromagnetic field, stop moving, and this lack of movement is detected by reflectance photometry. Each box of test
Results
Of the 51 patients who were randomized to group 1 (SMA group), 7 patients declined training. The reasons stated were distance from training center (n = 4), lack of confidence in ability to manage warfarin dosing (n = 2), and lack of confidence in ability to perform finger-prick sampling of blood (n = 1).
The remaining patients (n = 44) attended all the required training sessions. Of these patients, 3 were considered unsuitable for SMA as they either had difficulty with blood sampling or with
Comment
Most patients in our study were able to learn SMA, and we successfully trained 41 of 44 (93%) patients who attempted SMA. Of the 3 patients (6.8%) deemed unsuitable for SMA, 1 could not grasp the concept of self-dosing and the other 2 could not consistently measure their INR. It is interesting that one of the latter patients who had difficulty measuring her INR was a non–insulin-dependent diabetic who practiced home monitoring of her blood glucose levels. She had difficulty obtaining the 25 μL
Acknowledgements
We thank Roche Diagnostics (Lewes, Surrey, UK; formerly Boehringer Mannheim) for providing the Coaguchek coagulometers and test strips used in this study.
Copies of our training schedule and written tests for patients are available upon request.
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