Education for Patients Taking Anticoagulants
I am a certified provider of an education and treatment program for patients receiving longterm oral anticoagulation therapy and would have appreciated a deeper analysis of the data. Namely: are there any differences in the rates of complications between the trained and non-trained groups of patients taking phenprocoumon? Participants in the educational training program receive detailed information about and are made aware of the most important complications—which were also mentioned in the excellent original article—such as hemorrhage, interactions with other medications, and liver injuries. If there is a significant difference, it would be worth considering whether by default, all patients in whom long-term oral anticoagulation with phenprocoumon, warfarin, etc, is indicated should undergo such training, in order to prevent the frequency of complications and health related harms at the individual level, on the one hand, and financial burdens on the healthcare system on the other hand. The annual therapeutic cost of treatment with phenprocoumon and the NOACs differ by a factor of 10, which means that phenprocoumon costs about €80 and treatment with NOACs €600–1200 per person/year. The education program is an one-off expense at €170 per person, as is the measuring device (€900) and the test strips (56 per year), and in case of long-term treatment this would certainly be more cost effective in times where keeping contributions down takes priority.
A further, important piece of information: for the NOACs (apixaban, rivaroxaban, and dabigatran etexilate) no data from long term studies are available to date, no antagonists exist, and in case of a heart valve replacement they are not suitable as a therapeutic alternative.
Dr. med. Guntram Fischer
MVZ Immenstadt Allgäu GmbH, Immenstadt
Conflict of interest statement
Dr Fischer is the provider of an education and treatment program for patients receiving long-term oral anticoagulation treatment. He has received honoraria for speaking from Roche.