TY - JOUR
T1 - Predictors of anticoagulation quality in 15 834 patients performing patient self-management of oral anticoagulation with vitamin K antagonists in real-life practice
T2 - a survey of the International Self-Monitoring Association of Orally Anticoagulated Patients
AU - Schaefer, Christian
AU - Wuillemin, Walter A.
AU - Kessels, Alfons
AU - Jacobson, Alan
AU - Nagler, Michael
N1 - Publisher Copyright:
© 2016 John Wiley & Sons Ltd
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Although patient self-management (PSM) of oral anticoagulation with vitamin K antagonists is recommended for patients requiring long-term anticoagulation, important aspects are still unclear. Using data from a large international survey (n = 15 834; median age 72 years; 30·1% female), we studied predictors of poor anticoagulation control (percentage of International Normalized Ratio values within therapeutic range below 75%) and developed a simple prediction model. The following variables were identified as risk factors for poor anticoagulation control and included in the final model: higher intensity of therapeutic range (odds ratio [OR] on every level 1·9; 95% confidence interval [CI] 1·8–2·0), long intervals between measurements (>14 d; 1·5; 95% CI 1·3–1·7), female sex (OR 1·3; 95% CI 1·2–1·4), and management other than PSM (OR 1·4; 95% CI 1·2–1·6). At a threshold of 0·2 (at least one variable present), the model predicted poor anticoagulation control with a sensitivity of 85·3% (95% CI: 84·0, 86·4) and a specificity of 28·5% (27·6, 29·5). The area under the receiver operated characteristic curve was 0·65. Using the proposed prediction model, physicians will be able to identify patients with a low chance of performing well, considering additional training, regular follow-up, or adjustment of therapeutic ranges.
AB - Although patient self-management (PSM) of oral anticoagulation with vitamin K antagonists is recommended for patients requiring long-term anticoagulation, important aspects are still unclear. Using data from a large international survey (n = 15 834; median age 72 years; 30·1% female), we studied predictors of poor anticoagulation control (percentage of International Normalized Ratio values within therapeutic range below 75%) and developed a simple prediction model. The following variables were identified as risk factors for poor anticoagulation control and included in the final model: higher intensity of therapeutic range (odds ratio [OR] on every level 1·9; 95% confidence interval [CI] 1·8–2·0), long intervals between measurements (>14 d; 1·5; 95% CI 1·3–1·7), female sex (OR 1·3; 95% CI 1·2–1·4), and management other than PSM (OR 1·4; 95% CI 1·2–1·6). At a threshold of 0·2 (at least one variable present), the model predicted poor anticoagulation control with a sensitivity of 85·3% (95% CI: 84·0, 86·4) and a specificity of 28·5% (27·6, 29·5). The area under the receiver operated characteristic curve was 0·65. Using the proposed prediction model, physicians will be able to identify patients with a low chance of performing well, considering additional training, regular follow-up, or adjustment of therapeutic ranges.
KW - International Normalized Ratio
KW - anticoagulant administration/dosage
KW - drug monitoring
KW - self care
KW - vitamin K antagonists/inhibitors
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U2 - 10.1111/bjh.14273
DO - 10.1111/bjh.14273
M3 - Article
C2 - 27468696
SN - 0007-1048
VL - 175
SP - 677
EP - 685
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 4
ER -