Home health system helps give anticoagulated patients greater control
For most people, coagulation is one of the human body’s most unnoticed processes, although it is one of the most important. When a wound occurs and a blood vessel is damaged, a blood clot forms to stop the bleeding, which allows healing to begin.
Abnormal blood clotting can have life-threatening consequences for those suffering from conditions such as atrial fibrillation, deep vein thrombosis, pulmonary embolism, stroke or heart valve disease. The serious risk posed by clotting often requires these patients to take daily blood thinning medications and perform regular monitoring of clotting levels.
For millions of patients worldwide, managing these conditions involves frequent trips to the doctor’s office or anticoagulation clinic (often between two to four visits every month), which can interfere with work, family and travel commitments. Life can seem to revolve around these visits to have a blood test done, leading to frustration at the inconvenience and anxiety in anticipation of each new test result. The heightened risk of hospitalisation, should clotting levels veer dangerously out of range, can also mean extraordinary health care costs for both patients and providers.
Today, thanks to innovations in home health technology, some patients are breaking free of this cycle. Representing another step forward in the e-Health revolution, the new standard in anticoagulation therapy monitoring involves a hand-held meter that allows patients to test their own clotting levels, also known as PT/INR monitoring, from any location. Patients can then transmit the test results directly to the doctor using Bluetooth technology.
Self-testers achieve greater independence, while gaining the reassurance of knowing their result and having the ability to easily share it with their doctor. Patients can monitor their PT/INR levels as often as they wish – anytime, anywhere – and healthcare professionals can use the results to make immediate treatment decisions when necessary to keep their patients’ health on track.
Taking the correct dose is crucial for efficient anticoagulation treatment. The correct dose is established by measuring how long it takes blood to clot, and is called the Prothrombin Time / International Normalised Ratio (PT/INR). The proportion of time INR values are within the upper and lower target value is called Time in Therapeutic Range, or TTR. This is important because the more time patients are in range, the less chance of complications, such as blood clots or excessive bleeding.
Patient self-testing studies
Studies show that patients who self-test are more engaged in their own care, test more often and spend more time in range1 – 92 percent of patients who monitor at least every three days can expect to remain in their target range.2 Patients who spend a high proportion of time (> 70%) in the therapeutic range achieve better clinical outcomes.3,4 For providers, this could be a cost-effective approach: more patients in range may lead to fewer hospitalisations and thus a vast reduction in the associated health care costs. Some evidence also suggests that patients with a strong connection with their doctor through self-testing adhere better to therapy and experience stronger health outcomes as a result.1,2,5
For many people, travel is one of life’s great pleasures. This is also the case for Erika and Angelika who are both on anticoagulation therapy. Learn about their stories and what impact self-testing has had on their lives.
We talked to Dr. Christoph Sucker about why and how anticoagulation therapy and travelling can indeed be a healthy match and what patients need to consider.
1. Heneghan C, Ward A, Perera R, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet. 2012;379:322-334.
2. Khan TI, Kamali F, Kesteven P, Avery P, Wynne H. The value of education and self-monitoring in the management of warfarin therapy in older patients with unstable control of anticoagulation. Br J Haematol. 2004;126(4):557-654.
3. Gallagher, A.M., Setakis, E., Plumb, J.M., Clemens, A., van Staa, T.-P. (2011). Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients. Thromb Haemost 106, 968–977.
4. Wan, Y., Heneghan, C., Perera, R., Roberts, N., Hollowell, J., Glasziou, P. et al. (2008). Anticoagulation control and prediction of adverse events in patients withatrial fibrillation: a systematic review. Circ Cardiovasc Qual Outcomes 1, 84–91.
5. Levi, M., Hobbs, F.D.R., Jacobson, A.K., Pisters, R., Prisco, D. et al (2009). Semin Thromb Hemost 35:527-542.