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Original article

Vol. 141 No. 2122 (2011)

Implementation of an INR self-testing and self-management programme in common ambulatory private practice: our experience with 90 patients

  • G Gagneux
  • C Gavignet
  • F Boehlen
  • Moerloose de
Cite this as:
Swiss Med Wkly. 2011;141:w13199


QUESTIONS UNDER STUDY: INR self-testing devices allow patients on vitamin K antagonists (VKA) to determine their INR and then have their VKA dose adapted by a physician (INR self-testing, ST) or adapt it themselves according to pre-established guidelines (INR self-management, SM). The safety, efficacy and advantages of ST and SM have been demonstrated, but their use remains limited. In an effort to improve the availability of ST and SM, we tested the hypothesis that implementing a teaching programme for ST and SM in a small structure in common ambulatory private practice is feasible, safe and can lead to high patient satisfaction.

METHODS: Patients on long-term anticoagulation were assigned to a specific training programme. Patients used the CoaguChek (S then XS) INR testing system. Technical problems, adverse events and INR values were then recorded during the first year of follow-up and analysed. Patient satisfaction data were obtained via a specific questionnaire.

RESULTS: 169 patients were referred and 90 included in the teaching programme. 80 performed SM and 10 performed ST. 54 patients (60%) returned the 1-year questionnaire with complete INR data available for 35 patients. The percentage of INR in the target range (target ± 0.5) was 60.6%. The rate of major adverse clinical events (MACE) was 3.7 per 100 patient-years. The main reported advantages were a reduction in visits to the INR testing facility and increased autonomy. There was better venous to capillary INR correlation with the CoaguChek XS than with the S (p <0.025).

CONCLUSIONS:The development in a small structure in common ambulatory practice of a specific teaching programme made ST and SM available to a new patient population. It led to high patient satisfaction, significantly reducing the burden of VKA monitoring. These results were obtained while preserving the safety and efficacy standards of VKA treatment and favour greater expansion of ST and SM programmes.


  1. Filippi A, Sessa E, Trifiro G, Mazzaglia G, Pecchioli S, Caputi AP, et al. Oral anticoagulant therapy in Italy: prescribing prevalence and clinical reasons. Pharmacol Res. 2004;50(6):601–3.
  2. Nilsson GH, Bjorholt I, Johnsson H. Anticoagulant treatment in primary health care in Sweden – prevalence, incidence and treatment diagnosis: a retrospective study on electronic patient records in a registered population. BMC Fam Pract. 2003;4:3.
  3. Holm T, Lassen JF. How many patients are on oral anticoagulant therapy in Denmark? Methods to estimate the number. Ugeskr Laeger. 2003;165(18):1871–5.
  4. Hirsh J. Oral anticoagulant drugs. N Engl J Med. 1991;324(26):1865–75.
  5. Hirsh J, Dalen JE, Anderson DR, Poller L, Bussey H, Ansell J, et al. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 1998;114(5Suppl):445S–69S.
  6. Kapiotis S, Quehenberger P, Speiser W. Evaluation of the new method Coaguchek for the determination of prothrombin time from capillary blood: comparison with Thrombotest on KC-1. Thromb Res. 1995;77(6):563–7.
  7. Machin SJ, Mackie IJ, Chitolie A, Lawrie AS. Near patient testing (NPT) in haemostasis – a synoptic review. Clin Lab Haematol. 1996;18(2):69–74.
  8. Bereznicki LR, Jackson SL, Peterson GM, Jeffrey EC, Marsden KA, Jupe DM. Accuracy and clinical utility of the CoaguChek XS portable international normalised ratio monitor in a pilot study of warfarin home-monitoring. J Clin Pathol. 2007;60(3):311–4.
  9. Hentrich DP, Fritschi J, Müller PR, Wuillemin WA. INR comparison between the CoaguChek S and a standard laboratory method among patients with self-management of oral anticoagulation. Thrombosis research. 2007;119(4):489–95.
  10. Cromheecke ME, Levi M, Colly LP, de Mol BJ, Prins MH, Hutten BA, et al. Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomised cross-over comparison. Lancet. 2000;356(9224):97–102.
  11. Menendez-Jandula B, Souto JC, Oliver A, Montserrat I, Quintana M, Gich I, et al. Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med. 2005;142(1):1–10.
  12. Christensen TD, Maegaard M, Sorensen HT, Hjortdal VE, Hasenkam JM. Self-management versus conventional management of oral anticoagulant therapy: A randomized, controlled trial. Eur J Intern Med. 2006;17(4):260–6.
  13. Matchar DB, Jacobson A, Dolor R, Edson R, Uyeda L, Phibbs CS, et al. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363(17):1608–20.
  14. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet. 2006;367(9508):404–11.
  15. Fritschi J, Raddatz-Muller P, Schmid P, Wuillemin WA. Patient self-management of long-term oral anticoagulation in Switzerland. Swiss Med Wkly. 2007;137(17–18):252–8.
  16. Fitzmaurice DA, Machin SJ. Recommendations for patients undertaking self management of oral anticoagulation. Bmj. 2001;323(7319):985–9.
  17. Ansell J, Jacobson A, Levy J, Voller H, Hasenkam JM. Guidelines for implementation of patient self-testing and patient self-management of oral anticoagulation. International consensus guidelines prepared by International Self-Monitoring Association for Oral Anticoagulation. Int J Cardiol. 2005;99(1):37–45.
  18. Sobieraj-Teague M, Daniel D, Farrelly B, Coghlan D, Gallus A. Accuracy and clinical usefulness of the CoaguChek S and XS Point of Care devices when starting warfarin in a hospital outreach setting. Thrombosis research. 2009;123(6):909–13.
  19. Matchar DB JA, Dolor R, Edson R, Uyeda L, Phibbs CS, Vertrees JE, Shih MC, Holodniy M, Lavori P; THINRS Executive Committee and Site Investigators. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363(17):1608–20.
  20. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139–51.
  21. Garcia D, Libby E, Crowther MA. The new oral anticoagulants. Blood. 2009 Oct 30.
  22. Rivaroxaban-once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation: rationale and design of the ROCKET AF study. Am Heart J. 2010;159(3):340–7 e1.