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Rent Review: Always tread with care

Patient self-management of oral anticoagulation is safe, reliable and could improve care for patients with poor control, researchers conclude.

The strategy was as effective as usual care, with self-managing patients spending 70 per cent of the time in the INR therapeutic range, against 68 per cent of controls.

The trial of 443 patients, published online by the BMJ this week, also found self-managing patients who initially had poor control improved during the study, whereas usual care patients did not.

The size of this improvement was about 20 per cent in the 3.5 INR target group and about 15 per cent in the 2.5 target group. In the routine care group, a change of just 3 to 5 per cent was seen in both target groups.

Study leader Professor David Fitzmaurice, professor of primary care at the University of Birmingham, said: ‘I think people who are involved in managing patients receiving anticoagulation should consider self- management for some patients, but the patients need to be trained and followed-up appropriately.'

‘Self- management is not included in the enhanced service at the moment, but it should be,' he added.

Nine patients had serious adverse events in the self-managed group, compared with seven in the routine care group.

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