An evaluation of patient self-testing competency of prothrombin time for managing anticoagulation: pre-randomization results of VA Cooperative Study #481--The Home INR Study (THINRS).
Abstract
Prior studies suggest patient self-testing (PST) of prothrombin time (PT) can improve
the quality of anticoagulation (AC) and reduce complications (e.g., bleeding and thromboembolic
events). "The Home INR Study" (THINRS) compared AC management with frequent PST using
a home monitoring device to high-quality AC management (HQACM) with clinic-based monitoring
on major health outcomes. A key clinical and policy question is whether and which
patients can successfully use such devices. We report the results of Part 1 of THINRS
in which patients and caregivers were evaluated for their ability to perform PST.
Study-eligible patients (n = 3643) were trained to use the home monitoring device
and evaluated after 2-4 weeks for PST competency. Information about demographics,
medical history, warfarin use, medications, plus measures of numeracy, literacy, cognition,
dexterity, and satisfaction with AC were collected. Approximately 80% (2931 of 3643)
of patients trained on PST demonstrated competency; of these, 8% (238) required caregiver
assistance. Testers who were not competent to perform PST had higher numbers of practice
attempts, higher cuvette wastage, and were less able to perform a fingerstick or obtain
blood for the cuvette in a timely fashion. Factors associated with failure to pass
PST training included increased age, previous stroke history, poor cognition, and
poor manual dexterity. A majority of patients were able to perform PST. Successful
home monitoring of PT with a PST device required adequate levels of cognition and
manual dexterity. Training a caregiver modestly increased the proportion of patients
who can perform PST.
Type
Journal articleSubject
THINRS Site InvestigatorsHumans
Atrial Fibrillation
Hemorrhage
Warfarin
Anticoagulants
Drug Monitoring
International Normalized Ratio
Prothrombin Time
Self Care
ROC Curve
Heart Valve Prosthesis
Patient Selection
Adult
Aged
Aged, 80 and over
Middle Aged
Costs and Cost Analysis
Female
Male
Young Adult
Permalink
https://hdl.handle.net/10161/22913Published Version (Please cite this version)
10.1007/s11239-010-0499-8Publication Info
Dolor, Rowena J; Ruybalid, R Lynne; Uyeda, Lauren; Edson, Robert G; Phibbs, Ciaran;
Vertrees, Julia E; ... THINRS Site Investigators (2010). An evaluation of patient self-testing competency of prothrombin time for managing
anticoagulation: pre-randomization results of VA Cooperative Study #481--The Home
INR Study (THINRS). Journal of thrombosis and thrombolysis, 30(3). pp. 263-275. 10.1007/s11239-010-0499-8. Retrieved from https://hdl.handle.net/10161/22913.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Rowena Joy Dolor
Professor of Medicine
Rowena J. Dolor, MD, MHS did her medical training and internal medicine residency
at Duke University Medical Center. She completed the Ambulatory Care/Health Services
Research fellowship at the Durham VA Medical Center in 1996 and obtained her Masters
in Health Sciences degree in Biometry (renamed MHS in Clinical Research) from the
Duke University School of Medicine in 1998. Dr. Dolor was a staff physician in the
Ambulatory Care Service at the Durham VA Medical Center and Research Associate at
t
David Bruce Matchar
Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical
policies to their implementation in real world clinical settings. Most recently my
major content focus has been cerebrovascular disease. Other major clinical areas in
which I work include the range of disabling neurological conditions, cardiovascular
disease, and cancer prevention. Notable features of my work are: (1) reliance on
analytic strategies such as meta-analysis, simulation, decision analy
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info