Self-Management of Oral Anticoagulation Therapy Improves Long-Term Survival in Patients with Mechanical Heart Valve Replacement

Ann Thorac Surg 2007;83:24-29 © 2007 The Society of Thoracic Surgeons

Self-Management of Oral Anticoagulation Therapy Improves Long-Term Survival in Patients with Mechanical Heart Valve Replacement
Heinrich Koertke, MD_*, Armin Zittermann, PhD, Otto Wagner, Reiner Koerfer, MD, PhD

BACKGROUND: The Early Self-Controlled Anticoagulation Trial has demonstrated that in patients with mechanical heart valve replacement self-management of oral anticoagulation results in less major thromboembolic events than conventional measurement by the general practitioner.

RESULTS: Self-management of oral anticoagulation increased long-term survival by 23% (intent-to-treat analysis) and 33% (per protocol analysis), respectively, compared with conventional measurement by the general practitioner. Possible reasons for these advantageous results in the self-management group are fewer thromboembolic events due to a higher percentage of international normalized ratio values lying in the target range compared with the conventional group.

CONCLUSIONS: Data indicates that self-management of oral anticoagulation is a promising strategy in order to increase long-term survival in patients with mechanical prosthetic valves.

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