Association of level of activation for self-management with the degree of anticoagulation control in patients undergoing oral anticoagulant treatment

Abstract

Objective

To determine the association of level of activation for self-management with the degree of anticoagulation control in a group of chronically anticoagulated patients.

Methods

Cross-sectional study of patients treated with oral antivitamin-k drugs attended at a specialized outpatient anticoagulation unit between November 2021 and June 2022. International normalized ratio (INR) values over the past 6 months were recorded. The degree of INR control was defined as the time the patient had remained within the therapeutic range (TTR) and was determined by the Rosendaal method. A TTR value >60% was taken as representing adequate control. Simple and multiple logistic regression models were conducted, with degree of INR control as dependent variable.

Results

One hundred and thirty-seven patients were included. The mean age was 59.6 years (SD 13.8; range 22 - 86) and 60.6% were males. A total of 67.9% of patients (95%CI: 60.0 to 75.8) had adequate INR control. Factors independently associated with adequate INR control were high levels of activation according to the PAM-13 scale (OR: 1.05; 95%CI: 1.02–1.09) and self-management monitoring mode (OR: 7.12; 95%CI: 2.10–24.06).

Conclusion

The level of activation and the control mode were associated with a better degree of INR control. Knowing the factors associated with the degree of control allows us to identify the subgroups of chronic anticoagulated patients who require more individualized educational interventions. Self-management monitoring programs and patient activation appear to be useful tools in improving the INR control of anticoagulated patients.