Point-of-Care Testing in Oral Anticoagulant Monitoring: Implications for Patient Management

Abstract

Capillary whole blood point-of-care instruments for prothrombin time testing have been available for the last 10 years for use both in an office or hospital setting as well as at home by patients for self-monitoring of oral anticoagulant therapy. There are currently 4 types of instruments available, all of which initiate coagulation with thromboplastin, but the end-point determination of coagulation differs in the various instruments. The accuracy and precision of these instruments have been validated in a number of studies and their suitability for monitoring oral anticoagulation therapy has been established. A number of small pilot trials have assessed their value for patient self-testing at home and have produced preliminary evidence that such monitoring may produce better results than achieved with monitoring performed in the usual fashion. A number of studies have also shown that suitably educated patients can also manage their own dosage adjustments based on their own testing at home. Furthermore, preliminary studies also suggest that such monitoring is a cost-effective means of managing oral anticoagulation.Reviews-on-treatment, Coagulation-monitoring, Patient-education, Warfarin, Clinical-pharmacokinetics, Pharmacoeconomics, Self-medication, Anticoagulants, Economic-implications