An evaluation of patient self-testing competency of prothrombin time for managing anticoagulation: pre-randomization results of VA Cooperative Study #481¨CThe Home INR Study (THINRS)

详细信息    查看全文

• 作者：Rowena J. Dolor ; R. Lynne Ruybalid ; Lauren Uyeda ; Robert G. Edson ; Ciaran Phibbs ; Julia E. Vertrees ; Mei-Chiung Shih ; Alan K. Jacobson ; David B. Matchar and for the THINRS Site Investigators
• 关键词：Anticoagulation ; Patient self ; testing ; Atrial fibrillation ; Mechanical heart valve
• 刊名：Journal of Thrombosis and Thrombolysis
• 出版年：2010
• 出版时间：October 2010
• 年：2010
• 卷：30
• 期：3
• 页码：263-275
• 全文大小：265.6 KB

文摘

Prior studies suggest patient self-testing (PST) of prothrombin time (PT) can improve the quality of anticoagulation (AC) and reduce complications (e.g., bleeding and thromboembolic events). “The Home INR Study” (THINRS) compared AC management with frequent PST using a home monitoring device to high-quality AC management (HQACM) with clinic-based monitoring on major health outcomes. A key clinical and policy question is whether and which patients can successfully use such devices. We report the results of Part 1 of THINRS in which patients and caregivers were evaluated for their ability to perform PST. Study-eligible patients (n = 3643) were trained to use the home monitoring device and evaluated after 2–4 weeks for PST competency. Information about demographics, medical history, warfarin use, medications, plus measures of numeracy, literacy, cognition, dexterity, and satisfaction with AC were collected. Approximately 80 % (2931 of 3643) of patients trained on PST demonstrated competency; of these, 8 % (238) required caregiver assistance. Testers who were not competent to perform PST had higher numbers of practice attempts, higher cuvette wastage, and were less able to perform a fingerstick or obtain blood for the cuvette in a timely fashion. Factors associated with failure to pass PST training included increased age, previous stroke history, poor cognition, and poor manual dexterity. A majority of patients were able to perform PST. Successful home monitoring of PT with a PST device required adequate levels of cognition and manual dexterity. Training a caregiver modestly increased the proportion of patients who can perform PST.