The impact of frequency of patient self-testing of prothrombin time on time in target range within VA Cooperative Study #481: The Home INR Study (THINRS), a randomized, controlled trial
| Autor: | Robert Edson, Alan K. Jacobson, Lauren Uyeda, Sean R. Love, Ciaran S. Phibbs, Rowena J. Dolor, David B. Matchar |
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| Rok vydání: | 2014 |
| Předmět: |
Male
endocrine system medicine.medical_specialty Time Factors law.invention Quality of life Randomized controlled trial law Internal medicine medicine Clinical endpoint Humans International Normalized Ratio Stroke Aged Prothrombin time medicine.diagnostic_test business.industry fungi Warfarin food and beverages Atrial fibrillation Hematology Bleed Middle Aged medicine.disease Home Care Services United States Surgery Self Care United States Department of Veterans Affairs Prothrombin Time Female Drug Monitoring Cardiology and Cardiovascular Medicine business medicine.drug Follow-Up Studies |
| Zdroj: | Journal of thrombosis and thrombolysis. 40(1) |
| ISSN: | 1573-742X |
| Popis: | Anticoagulation (AC) is effective in reducing thromboembolic events for individuals with atrial fibrillation (AF) or mechanical heart valve (MHV), but maintaining patients in target range for international normalized ratio (INR) can be difficult. Evidence suggests increasing INR testing frequency can improve time in target range (TTR), but this can be impractical with in-clinic testing. The objective of this study was to test the hypothesis that more frequent patient-self testing (PST) via home monitoring increases TTR. This planned substudy was conducted as part of The Home INR Study, a randomized controlled trial of in-clinic INR testing every 4 weeks versus PST at three different intervals. The setting for this study was 6 VA centers across the United States. 1,029 candidates with AF or MHV were trained and tested for competency using ProTime INR meters; 787 patients were deemed competent and, after second consent, randomized across four arms: high quality AC management (HQACM) in a dedicated clinic, with venous INR testing once every 4 weeks; and telephone monitored PST once every 4 weeks; weekly; and twice weekly. The primary endpoint was TTR at 1-year follow-up. The secondary endpoints were: major bleed, stroke and death, and quality of life. Results showed that TTR increased as testing frequency increased (59.9 ± 16.7 %, 63.3 ± 14.3 %, and 66.8 ± 13.2 % [mean ± SD] for the groups that underwent PST every 4 weeks, weekly and twice weekly, respectively). The proportion of poorly managed patients (i.e., TTR |
| Databáze: | OpenAIRE |
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