CC BY-NC-ND 4.0 · Thromb Haemost 2019; 19(10): 1632-1641
DOI: 10.1055/s-0039-1693703
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Quality of Warfarin Therapy and Quality of Life are Improved by Self-Management for Two Years

Una Ørvim Sølvik
1  Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
,
Elisabeth Løkkebø
2  Norwegian Organization of Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
,
Ann Helen Kristoffersen
2  Norwegian Organization of Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
3  Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
,
Ellen Brodin
4  Division of Medicine, Department of Hematology, Akershus University Hospital, Lørenskog, Norway
,
Maria Averina
5  Department of Laboratory Medicine, The University Hospital of North Norway, Tromsø, Norway
,
Sverre Sandberg
1  Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
2  Norwegian Organization of Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
3  Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
› Author Affiliations
Funding This study has been financially supported by Helse Nord, Norway.
Further Information

Publication History

04 February 2019

13 June 2019

Publication Date:
01 August 2019 (eFirst)

  

Abstract

Background Studies from several countries show that self-management of vitamin K antagonist (e.g., warfarin) therapy reduce the risk of complications compared with conventional management.

Objectives The aim of this study was to investigate the quality of warfarin management when patients were transferred from conventional management to self-management in Norway. In addition, quality of life (QoL) before and after 2 years of warfarin self-management was investigated.

Materials and Methods The study was longitudinal with a retrospective and prospective design where 126 patients on conventional management of long-term warfarin therapy underwent a 21-week training program of warfarin self-management followed by 2 years of self-management. The outcomes of the study were time in therapeutic range (TTR), the variance of international normalized ratio (INR) values, extreme INR values (INR ≤ 1.5 and ≥ 5), complications, and QoL, comparing the 2-year period of the conventional management with the 2-year period with the self-management.

Results The median TTR was higher during self-management compared with conventional management (78.1% vs. 65.9%, respectively, p < 0.001). In addition, self-management resulted in lower INR variance (0.22 vs. 0.33, p < 0.001), reduced percentage of extreme INR values (1.8% vs. 5.3%, p < 0.001), less complications (0% vs. 5.6%), and improved QoL (p < 0.001) compared with conventional management.

Conclusion We used five different measures and found improved quality of warfarin self-management 2 years after patients were transferred from the conventional management.

Supplementary Material