Patient, heal thyself: the ongoing evolution of patient self-directed care and hand-held technology.

摘要

Medical conditions that require long-term anticoagu-lation with warfarin are prevalent in the United States and worldwide. In the United States, atrial fibrillation affects approximately 1% of the population and is the primary condition for which long-term anticoagulation is given. Other conditions requiring long-term anticoagulation, such as venous thromboembolism and mechanical prosthetic heart valves, are also common (1, 2). Although treatment with warfarin has been shown to reduce the incidence of stroke and mortality, 20% to 30% of patients who receive warfarin therapy are inadequately treated (3, 4). This is because warfarin has a narrow therapeutic window; is associated with numerous drug-drug interactions; and has unique pharmacokinetics, which makes it difficult to predict optimal dosing. In addition, studies have shown important genetic contributors to warfarin dose requirements (5, 6). As a result, patients need to make frequent visits to specialized anticoagulation clinics or care-provider offices to adjust warfarin dosing to maintain an appropriate protime international normalized ratio (INR), making the current method of anticoagulation care time-consuming and inefficient. Such obstacles have prompted the search for alternative strategies or agents to ensure that patients who require long-term anticoagulation are more optimally and consistently treated.