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Predictors of anticoagulation quality in 15 834 patients performing patient self‐management of oral anticoagulation with vitamin K antagonists in real‐life practice: a survey of the International Self‐Monitoring Association of Orally Anticoagulated Patients
Author(s) -
Schaefer Christian,
Wuillemin Walter A.,
Kessels Alfons,
Jacobson Alan,
Nagler Michael
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14273
Subject(s) - medicine , confidence interval , odds ratio , target range , receiver operating characteristic , quality of life (healthcare) , economics , macroeconomics , nursing
Summary 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.