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ePaper created 2014-10-06, 13:17:01 | version 1.33.00
ORIGINAL RESEARCH The Clinical Impact of Different Coagulometers on Patient Outcomes Jan Leendert Pouwel Brouwer • Hugo Stoevelaar • Christoph Sucker To view enhanced content go to www.advancesintherapy.com Received: April 9, 2014 Ó The Author(s) 2014. This article is published with open access at Springerlink.com ABSTRACT Introduction: Long-term anticoagulation therapy using vitamin K antagonists (VKA) is used in millions of patients worldwide to reduce the risk of thrombotic or thromboembolic events. Control and monitoring of VKA therapy is improved by the regular self- measurement of international normalized ratio (INR) using a home monitoring device. This retrospective analysis of a large cohort of patients in the Netherlands seeks to determine whether the choice of INR monitor could have a clinical impact on patient outcomes. Methods: The National Thrombosis Service provides medical supervision, training and support to anticoagulant patients eligible for home-monitoring of INR in the Netherlands. Two INR monitors (CoaguChek XS and INRatio2) have been distributed at random to patients since June 2011, and patient self- testing data (INR measurements and other clinical parameters) have been recorded to measure and improve treatment outcomes. The data have been retrospectively analyzed to determine any effect of the choice of monitor. Univariate and multivariate statistical tests are used to assess any differences between groups in terms of efficacy and safety parameters. Results: Data from 4,326 patients were collated, and 156,507 INR values were included in the analysis. Over half the patients (54.3%) were being treated for atrial fibrillation, and 77.6% were prescribed acenocoumarol. There were few differences between the patient populations using the two different monitors. Anticoagulant control overall was good, with high percentage of time (87.9%) in the appropriate INR range and low incidence of excessively high or low INR values (0.085/ month). Minor clinical events related to safety Electronic supplementary material The online version of this article (doi:10.1007/s12325-014-0124-x) contains supplementary material, which is available to authorized users. J. L. P. Brouwer (&) Á H. Stoevelaar De Nationale Trombose Dienst (The National Thrombosis Service), Zonneoordlaan 17, 6718 TK Ede, The Netherlands e-mail: janleendert.brouwer@ntd.nl J. L. P Brouwer Department of Cardiology, Pasana Care Group, Birdaarderstraatweg 70, 9101 DC Dokkum, The Netherlands C. Sucker LaboMed Coagulation Center, Tauentzienstrasse 7 b/c, 10789 Berlin, Germany Adv Ther DOI 10.1007/s12325-014-0124-x