Portable coagulometer for vitamin K-antagonist monitoring: the patients’ point of view
Received 5 February 2018
Accepted for publication 16 May 2018
Published 22 August 2018 Volume 2018:12 Pages 1521—1526
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 4
Editor who approved publication: Dr Johnny Chen
Doris Barcellona, Diego Mastino, Francesco Marongiu
Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
Purpose: The aim of this study was to know the patients’ point of view on the monitoring of vitamin K-antagonist (VKA) therapy by means of a point of care testing (POCT), ie, using a portable coagulometer by self-testing at home. At first, patients had prothrombin time (PT) international normalized ratio (INR) monitoring at a thrombosis center; afterward, they were shifted to self-testing at home. An interview was done to evaluate the patients’ point of view on the two monitoring periods.
Patients and methods: A total of 92 oral anticoagulated patients were enrolled. The questionnaire contained nine questions that elicited a maximum of five closer answers that were arranged in increasing levels of satisfaction: very little, little, enough, much and completely. Percentage of time in therapeutic range (TTR) and adverse events were compared during the two periods of conventional monitoring and self-testing.
Results: The period of conventional monitoring was shorter than that of self-testing (p<0.0001), and the median TTR was satisfactory but lower than that of self-testing (p<0.0001). A total of 85% of the patients were satisfied with self-testing at home. In all, 83% and 73% (p=0.06) of patients felt comfortable about side effects while measuring the PT INR at both home and the thrombosis center, respectively. During the self-testing period, quality of life was improved in 87% of the patients. The cost of test strips was medium–high for 89% of the patients, and 75% of them stated that it was worth improving their quality of life. A switch from VKA to a direct oral anticoagulant (DOAC) was proposed to 24% of the patients, but 68% of them declined because they felt more comfortable monitoring their oral anticoagulant therapy by POCT.
Conclusion: VKA monitoring using POCT at home may play a role in improving the patients’ quality of life and may be considered as an alternative to the use of DOAC at least in certain settings of patients.
Keywords: oral anticoagulants, self-testing, quality of life
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