Patients know best when it comes to blood thinners

Study: Patients with blood-clotting problems, such as Sharon, can be more successful than their doctors at treating themselves.

By JUDY SIEGEL
blood thinner 88 (photo credit: )
blood thinner 88
(photo credit: )
Patients with blood-clotting problems who are taught in a few hours to balance their coagulation levels with the powerful blood-thinning drug Coumadin instead of depending on medical personnel can succeed even better than their doctors, according to a research project by a student at the Hebrew University-Hadassah Medical School. Prime Minister Ariel Sharon had been given several anticoagulant drugs after his mild ischemic stroke, which was caused by a blood clot in his heart that reached his brain but did not cause any permanent damage. He was treated with blood thinners to prevent another ischemic stroke, but then on January 4 suffered his devastating hemorrhagic stroke, from which he remains in a deep coma. Sharon did not receive Coumadin, as this drug remains in effect for several days, and its use must be suspended before surgery or the coronary catheterization that he had been scheduled to undergo to close a congenital hole in his heart. With 50,000 Israelis taking Coumadin - which blocks the activity of vitamin K and reduces clotting - after undergoing heart-valve surgery or suffering from blood clots in various parts of their body, "self-management" of blood coagulation can save many lives and a lot of money. It can also serve as a model of educated patients monitoring their own health, says Prof. Mayer Brezis, head of the Center for Clinical Quality and Safety of the Hadassah Medical Organization, who was one of the supervisors of the project carried out by newly graduated Dr. Hanan Goldberg. Brezis, a kidney specialist, said the project can be applied to a wide variety of drug regimens and medical conditions, adding that patients should be educated about all the drugs they are prescribed. "When they are discharged from hospital, patients are given oral or written instructions about follow-up, but often they don't take the drugs or don't take them properly. When they know how the drugs work and what to look for, they will be much better off." Goldberg, who is now an IDF doctor, developed a unique scale that enables patients to determine - after testing their blood consistency (called INR) periodically at home with a CoaguCheck home device or going to their health fund lab - how much of the drug they need to take. This week's British medical journal The Lancet carried an article showing the benefits of self-management of blood coagulation, but Hadassah is apparently the only Israeli medical center to supply kits and educational equipment to patients who want to monitor themselves.