Self-management of anticoagulants in elderly could be beneficial

Jul 10 2012

By Piriya Mahendra

Elderly patients who self-manage their oral anticoagulant treatment have a comparable treatment-related quality of life (QoL) to those who undergo routine care, and may even experience higher treatment satisfaction, researchers say.

Andrea Siebenhofer (Goethe University, Frankfurt, Germany) and team found that at baseline, both groups of patients had high QoL scores for general treatment satisfaction, self-efficacy, daily hassles, and strained social network.

After 3 years of follow-up, patients who performed self-management of their oral anticoagulant treatment showed a significantly greater improvement in general treatment satisfaction than those who underwent routine care, at a median score increase from baseline of 0.9 versus 0.0 (p=0.002).

In addition, patients who self-managed showed improvements in their median score for general psychologic distress (-0.14 vs -0.43) and strained social networks (-0.13 vs 0.0) compared to the routine care group, but these differences did not reach statistical significance.

As reported in Thrombosis Research, there was also no significant difference between the groups with regard to daily hassle (defined as minor stressful events that frequently negatively impact QoL) and self-efficacy (patient's belief in being able to take care of themself).

Subgroup analysis demonstrated that the most pronounced improvement in QoL measures observed with self-management was general treatment satisfaction, regardless of whether this strategy was compared with routine care in a general practice setting or in an anticoagulation clinic (0.90 vs 0.0 for both, p<0.048 for both).

The study involved 141 patients aged 60 years or over, 68 of whom were randomly allocated to self-management, and 73 of whom received routine care.

The self-management group attended a structured teaching program over four consecutive weekly sessions during which they gained a theoretical understanding of oral anticoagulation under the guidance of an anticoagulation nurse.

Routine care patients received basic theoretical information on oral anticoagulation including the potential risks of thromboembolism and bleeding; and potential problems in special situations such as exercise, diet, and travel changes, during a single session.

"Although we found self-management to be statistically superior in some aspects of QoL, these results should be interpreted with caution," warn the authors.

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