Intervention Review

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Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation

  1. Danielle E Clarkesmith1,
  2. Helen M Pattison2,
  3. Deirdre A Lane1,*

Editorial Group: Cochrane Heart Group

Published Online: 4 JUN 2013

Assessed as up-to-date: 8 AUG 2012

DOI: 10.1002/14651858.CD008600.pub2

How to Cite

Clarkesmith DE, Pattison HM, Lane DA. Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008600. DOI: 10.1002/14651858.CD008600.pub2.

Author Information

  1. 1

    University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK

  2. 2

    Aston University, School of Life and Health Sciences, Birmingham, Birmingham, UK

*Deirdre A Lane, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham, B18 7QH, UK.

Publication History

  1. Publication Status: New
  2. Published Online: 4 JUN 2013



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Beyth 2000 {published data only}
  • Beyth RJ, Landefeld CS. Multicomponent comprehensive care was as effective as usual care for decreasing major bleeding in older patients on warfarin. Evidence Based Medicine 2001;6:116.
  • Beyth RJ, Quinn L, Landefeld S. A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin. Annals of Internal Medicine 2000;133(9):687-95.
Christensen 2007 {published data only}
  • Christensen TD, Maegaard M, Sorensen HT, Hjortdal VE, Hasenkam. Self-versus conventional management of oral anticoagulant therapy. American Journal of Cardiovascular Drugs 2007;7(3):191-7.
  • Christensen TD, Maegaard M, Sorensen HT, Hjortdal VE, Hasenkam JM. Self-management versus conventional management of oral anticoagulant therapy: A randomised, controlled trial. European Journal of Internal Medicine 2006;17:260-6.
Gadisseur 2003 {published data only}
  • Gadisseur APA, Breukink-Enghers WGM, van der Meer FJM, van den Besselaar AMH, Sturk A, Rosendaal FR. Comparison of the quality of oral anticoagulant therapy through patient self-management by specialized anticoagulation clinics in the Netherlands. Archives of Internal Medicine 2003;163(24):2639-46.
  • Gadisseur APA, Kaptein AA, Breukink-Engbers WGM, Van der meer FJM, Rosendaal FR. Patient self-management of oral anticoagulant care vs. management by specialized anticoagulation clinics: positive effects on quality of care. Journal of Thrombosis and Haemostasis 2004;2:584-91.
Man-Son-Hing 1999 {published data only}
McAlister 2005 {published data only}
  • McAlister FA, Man-Son-Hing M, Straus SE, Ghali WA, Anderson D, Majumdar SR, et al. for the Decision Aid in Atrial Fibrillation (DAAFI) Investigators. Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomised trial. Canadian Medical Association Journal 2005;173(5):496-501.
  • McAlister FA, Man-Son-Hing M, Straus SE, Ghali WA, Gibson P, Anderson D, et al. A randomised trial to assess the impact of an antithrombotic decision aid in patients with nonvalvular atrial fibrillation: the DAAFI trial protocol [ISRCTNI4429643]. BMC Cardiovascular Disorders 2004;4:5.
Polek 2012 {published data only}
Thomson 2007 {published data only}
  • Thomson RG, Eccles MP, Steen IN, Greenaway J, Stobbart L, Murtagh MJ, May CR. A patient decision aid to support shared decision-making on anti-thrombotic treatment of patients with atrial fibrillation: a randomised controlled trial. Quality and Safety in Health Care 2007;16:216-23. [DOI: 10.1136/qshc.2006.018481; : ]
Voller 2005 {published data only}
  • Voller H, Glatz J, Taborski U, Bernado A, Dovifat C, Bunkard G, Heidinger K. [Hintergrund und Prufplan der studie zum Selbstmanagement der Antikoagulation bei Patient mit nichtvalvularem Vorhofflimern (SMAAF-studie)]. Zeitschrift fur Kardiologie 2000;89:284-8.
  • Voller H, Glatz J, Taborski U, Bernardo A, Dovifat C, Heidinger K. Self-management of oral anticoagulation in nonvalvular atrial fibrillation (SMAAF study) [Selbstmanagement de antikoagulation bei patienten mit nichtvalvularem vorhofflimmern]. Zeitschrift fur Kardiologie 2005;94(3):183-6.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Armstrong 2011 {published data only}
  • Armstrong EP, Chemodurow L, Christensen S, Johnson ES. A pre- post-evaluation of implementing an inpatient monitoring and education program. Pharmacy Practice 2011;9(2):101-5.
Bajorek 2005 {published data only}
Baker 1991 {published data only}
Barcellona 2006 {published data only}
Batty 2001 {published data only}
  • Batty G, Oborne CA, Hooper R, Jackson S. Investigation of intervention strategies to increase the appropriate use of antithrombotics in elderly hospital inpatients with atrial fibrillation. The Journal of Clinical Governance 2001;9:115-22.
Blaise 2009 {published data only}
  • Blaise S, Satger B, Fontaine M, Yver J, Rastel D, Toffin L, et al. Evaluation of an education program for patients taking oral anticoagulants: Experience of the GRANTED network in Isere [Evaluation d'un programme d'education therapeutique pour les traitments anticoagulants oraux: exerience du reseau Ville-Hopital GRANTED du secteur Sud-Isere]. Journal des Maladies Vasculaires 2009;34:346-53. [DOI: 10.1016/j.jmv.2009.07.088]
Bloomfield 2011 {published data only}
  • Bloomfield HE, Krause A, Greer N, Taylor BC, MacDonald R, Rutks I, et al. Meta-analysis: effect of patient self-testing and self-management of long-term anticoagulation on major clinical outcomes. Annals of Internal Medicine 2011;154(7):472-w-160.
Bump 1977 {published data only}
  • Bump CM, Campbell JG. The relationship of patient education to the clinical course of patients receiving anticoagulants. Abstracts of Hospital Management Studies 1977;14(2):18091.
Burns 2009 {published data only}
Castelino 2010 {published data only}
  • Castelino RL, Chen TF, Guddattu V, Bajorek BV. Use of evidence-based therapy for the prevention of cardiovascular events among older people. Evaluation & the Health Professions 2010;33(3):276-301.
Chan 2006 {published data only}
Christensen 2011 {published data only}
  • Christensen H, Lautertein JJ, Sorensen PD, Petersen ERB, Madsen JS, Brandslund I. Home management of oral anticoagulation via telemedicine versus conventional hospital-based treatment. Telemedicine and e-Health 2011;17(3):169-76. [DOI: 10.1089/tmj.2010.0128]
Claes 2005 {published data only}
  • Claes N, Buntinx F, Vijgen J, Arnout J, Vermylen J, Fieuws S, Van LH. The Belgian improvement study on oral anticoagulation therapy: a randomized clinical trial. European Heart Journal 2005;26(20):2159-65.
Claes 2006 {published data only}
Corbella 2009 {published data only}
  • Corbella A, Bottari L, Cevasco I, Giacobbe S, Roba I, Rossini S, Tognarelli M. Patients in chronic anticoagulation therapy: the organization of an educational program run by nurses and the assessment of patients' satisfaction [Le persone in Terapia Anticoagulante Orale (TAO): costruzione di un intervento gestito dagli infermieri e valutazione del gradimento]. Assistenza Infermieristica e Ricerca 2009;28(2):65-72.
Cordasco 2009 {published data only}
Cromheecke 2000 {published data only}
  • Cromheecke ME, Levi M, Colly LP, de Mol BJM, Prins MH, Hutten BA, et al. Oral anticoagulation self-management and management by a specialist anticoagulation clinic: a randomised cross-over comparison. Lancet 2000;356(8):97-102.
Cromheecke 2001 {published data only}
  • Cromheecke ME, Levi M, Colly LP. Self management of long term oral anticoagulation was as effective as specialist anticoagulation clinic management. Evidence-Based Medicine 2001;6(2):41.
Davis 2005 {published data only}
Dolor 2010 {published data only}
  • Dolor RJ, Ruybalid RL, Uyeda L, Edson RG, Phibbs C, Vertrees JE, et al. and the THINRS site investigators. 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 2010;30:263-75.
Duran-Parrondo 2011 {published data only}
  • Duran-Parrondo C, Vazquez-Lago JM, Campos-Lopez AM, Figueras A. Impact of a pharmacotherapeutic programme on control and safety of long-term anticoagulation treatment. Drug Safety 2011;34(6):489-500.
Field 2010 {published data only}
  • Field TS, Tjia J, Mazor KM, Donovan JL, Kanaan AO, Harrold LR, et al. Randomized trial of a warfarin communication protocol for nursing homes: an SBAR-based approach. The American Journal of Medicine 2011;124:2.
Fitzmaurice 1996 {published data only}
  • Fitzmaurice DA, Hobbs FDR, Murray ET, Bradley CP, Holder R. Evaluation of computerized decision support for oral anticoagulation management based in primary care. British Journal of General Practice 1996;46:533-5.
Fitzmaurice 2000 {published data only}
  • Fitzmaurice DA, Hobbs FD, Murray ET. A nurse led clinic and computer decision support software for anticoagulation decisions were as effective as a hospital clinic. Evidence Based Medicine 2001;6:61.
  • Fitzmaurice DA, Hobbs FD, Murray ET, Holder RL, Allan TF, Rose PE. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomised, controlled trial. Archives of Internal Medicine 2000;160(15):2343-8.
Fitzmaurice 2005 {published data only}
  • Fitzmaurice DA, Murray ET, Gee KM. A randomised controlled trial of patient self management of oral anticoagulation treatment compared with primary care management. Journal of Clinical Pathology 2002;55:845-9. [DOI: 10.1136/jcp.55.11.845]
  • Fitzmaurice DA, Murray ET, McCahon MD, Holder R, Raferty JP, Hussain S, et al. Self management of oral anticoagulation: randomised trial. BMJ 2005;331(7524):1057. Erratum in: BMJ 2005 331(7528):1330. [DOI: 10.1136/bmj.38618.580903.AE; : ISRCTN 19313375]
  • Murray E, Fitzmaurice D, MaCahon D, Fuller C, Sandhur H. Training for patients in a randomised controlled trial of self management of warfarin treatment. BMJ 2004;328(21):437.
Fraenkel 2011 {published data only}
  • Fraenkel L, Street RL, Fried TR. Development of a tool to improve the quality of decision making in atrial fibrillation. BMC Medical Informatics and Decision Making 2011;11:59.
Gardiner 2006 {published data only}
Gouin-Thibault 2010 {published data only}
Grunau 2011 {published data only}
  • Grunau B, Wiens MO, Harder KK. Patient self-management of warfarin therapy. Canadian Family Physician 2011;57:292-8.
Hasan 2011 {published data only}
  • Hasan SS, Sharmala R, Syed IA, Basariah N, Chong DWK, Mei TK, Chin OH. Factors affecting warfarin-related knowledge and INR control of patients attending physician- and pharmacist-managed anticoagulation clinics. Journal of Pharmacy Practice 2011;24(5):485-93.
Holbrook 2007 {published data only}
  • Holbrook A, Labiris R, Goldsmith CH, Ota K, Harb S, Sebaldt RJ. Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial. Canadian Medical Association Journal 2007;176(11):1583-7.
Jackson 2004 {published data only}
Khan 2004 {published data only}
Krause 2010 {published data only}
  • Krause A, Bloomfield H, Wilt T. Safety and effectiveness of patient-managed outpatient anticoagulation: A systematic review. Journal of General Internal Medicine 2010;25:S387.
Landefeld 1992 {published data only}
Leger 2004 {published data only}
  • Leger S, Allenet B, Pichot O, Figari G, Calop J, Carpentier P, Bosson JL. Impact of an education program on patient behaviour favoring prevention of drug-related adverse events: a pilot study in patients receiving oral anticoagulants for thromboembolic venous disease [Impact d'un pragramme d'education therapeutique sur les attitudes de prevention vis-s-vis du risque iatrogene: etude pilote controlee visant les patients sous-anticoagulants oraux pour maladie thromboembolique veineuse]. Journal des Maladies Vasculaires 2004;29(3):152-8.
Machtinger 2007 {published data only}
  • Machtinger EL, Wang F, Chen LL, Rodriguez M, Wu S, Schilinger D. A visual medication schedule to improve anticoagulation control: A randomised controlled trial. The Joint Commission Journal on Quality and Patient Safety 2007;33(10):625-35.
Matchar 2005 {published data only}
  • Matchar DB, Jacobson AK, Edson RG, Lavori PW, Ansell JE, Ezekowitz MD, et al. The impact of patient self-testing of prothrombin time for managing anticoagulation: Rationale and design of VA cooperative study #481 - the home INR study (THINRS). Journal of Thrombosis and Thrombolysis 2005;19(3):163-72.
Matchar 2010 {published data only}
  • Matchar DB, Jacobson A, Dolor R, Edson R, Uyeda L, Phibbs CS, et al. Effect of home testing of international normalised ratio on clinical events. The New England Journal of Medicine 2010;363(17):1608-20.
Mazor 2007 {published data only}
McCahon 2011 {published data only}
  • McCahon D, Fitzmaurice DA, Murray ET, Fuller CJ, Hobbs RFD, Allan TF, Raferty JP. SMART: Self-management of anticoagulation, a randomised trial. BMC Family Practice 2003;4:11.
  • McCahon D, Murray ET, Murray K, Holder RL, Fitzmaurice DA. Does self-management of oral anticoagulation therapy improve quality of life and anxiety?. Family Practice 2011;28(2):134-40.
Megden 1999 {published data only}
  • Megden TH, Heidgen FJ, Vetter H. Optimization of long term control of oral anticoagulation by patient self-management [Verbesserung der langzeitkontrolle der oralen antikoagulation durch patienten-selbstmanagement]. Herz Kreislauf 1999;31(10):393-7.
Menendez-Jandula 2005 {published data only}
  • Menendez-Jandula B, Souto J, Oliver A, Monserrat I, Quintana M, Gich I, Bonfill X, Fontcuberta J. Comparing self-management of oral anticoagulant therapy with clinic management. Annals of Internal Medicine 2005;145:1-10.
  • Menendez-Jandula B, Souto JC, Oliver A. Patient self management of anticoagulants resulted in fewer major complications than clinic-based management. Evidence Based Nursing 2005;142:1-10.
Nedaz 2002 {published data only}
  • Nedaz M. Atrial fibrillation, anticoagulation and shared decision making [Fibrillation auriculaire et partage avec le patient de la decision d'anticoaguler]. Medecine et Hygiene 2002;60(2412):2054-8.
Nilsson 2011 {published data only}
  • Nilsson N, Eide TH, Kjeldhy C, Refsum N, Dahle G. What knowledge do patients on warfarin have about their treatment, and may patient education by a pharmacist improve their knowledge?. International Journal of Clinical Pharmacy 2011;33:418.
Pernod 2008 {published data only}
Polzien 2007 {published data only}
  • Polzien G. Prevent medication errors: a new year's resolution. Home Healthcare Nurse 2007;25(1):59-62.
PRISM Study group 2003 {published data only}
  • Lees KR, Sim I, Wier CJ, Erwin L, McAlpine C, Rodger J, et al. Cluster-randomized, controlled trial of computer-based decision support for selecting long-term anti-thrombotic therapy after acute ischaemic stroke. QJM: An International Journal of Medicine 2003;96:143-53. [DOI: 10.1093/qjmed/hcg019]
Reverdin 2011 {published data only}
  • Reverdin S, Schnetzler B, Gagneux G, Gavignet C, Boehlen F, Moerloose P. Implementation of an INR self-testing and self-management programme in common ambulatory private practice: our experience with 90 patients. Swiss Medical Weekly 2011;141:w13199.
Ryan 2009 {published data only}
Saokaew 2010 {published data only}
Satger 2009 {published data only}
  • Satger B, Blaise S, Fontaine M, Yver J, Allenet B, Baudrant M, et al. Therapy education for patients receiving oral anti-coagulants vitamin K antagonists [Education therapeutique des patients traites par anticoagulants oraux antivitamines k]. La Presse Medicale 2009;38(12):1780-7. [DOI: 10.1016/j.lmp.2009.07.019]
Sawicki 1999 {published data only}
  • Sawicki PT, for the working group for the study of patient self-management of oral anticoagulation. A structured teaching and self-management program for patients receiving oral anticoagulation. JAMA 1999;281(2):145-50.
Sawicki 2003 {published data only}
  • Sawicki PT, Blaser B, Didjurgeit U, Kaiser T, Kleepies C, Schmitz N, Stubbe J. Long-term results of patient's self-management of oral anticoagulation. Journal of Clinical and Basic Cardiology 2003;6(1-4):59-62.
Siebenhofer 2007 {published data only}
  • Siebenhofer, A, Rakovac I, Kleepies C, Piso B, Didjurgeit U. Self-management of oral anticoagulation in the elderly: Rationale, design, baselines and oral anticoagulation control after one year follow-up. Blood Coagulation, Fibrinolysis and Cellular Haemostasis 2007;97:408-16. [DOI: 10.1160/TH06-08-0482]
Stone 1989 {published data only}
  • Stone S, Holden A, Knapic N, Ansell J. Comparison between videotape and personalized patient education for anticoagulant therapy. The Journal of Family Practice 1989;29(1):55-7.
Sunderji 2005 {published data only}
  • Sunderji R, Gin K, Shalansky K, Carter C, Chambers K, Davies C, et al. Clinic impact of point-of-care vs laboratory measurement of anticoagulation. American Journal of Clinical Pathology 2005;123:184-8.
Taylor 1997 {published data only}
Trivalle 2010 {published data only}
  • Trivalle C, Cartier T, Verny C, Mathieu AM, Davrinche P, Agostini H, et al. and the IMEPAG Group. Identifying and preventing adverse drug events in elderly hospitalised patients: a randomised trial of a program to reduce adverse drug effects. The Journal of Nutrition, Health and Ageing 2010;14(1):57-61.
Tuiskula 2011 {published data only}
  • Tuiskula KA, Sullivan KM, Abraham G, Lahoz MR. Revising warfarin patient education materials to meet a national patient safety goal. American Journal Health-System Pharmacy 2011;68:974-6.
Vadher 1996 {published data only}
  • Vadher B, Patterson DLH, Leaning M. Comparison of oral anticoagulant control by nurse-practitioner using a decision-aid with that by clinicians. British Journal of Haematology 1996;93(1):31.
Vadher 1997 {published data only}
Waterman 2001 {published data only}
  • Waterman AD, Miligan PE, Banet GA, Gatchel SK, Gage BF. Establishing and running an effective telephone-based anticoagulation service. Journal of Vascular Nursing 2001;19:4.
Waterman 2001 b {published data only}
Watzke 2000 {published data only}
  • Watzke HH, Forberg E, Svolba G. A prospective controlled trial comparing weekly self-testing and self-dosing with the standard management of patients on stable oral anticoagulation. Thrombosis and Haemostasis 2000;83:661-5.
Winans 2010 {published data only}
Witt 2005 {published data only}
Woodend 2005 {published data only}
  • Woodend AK. Patient self management of anticoagulants resulted in fewer major complications than clinic-based management. Evidence-Based Nursing 2005;8(3):87.
Wurster 2006 {published data only}
  • Wurster M, Doran T. Anticoagulation management: A new approach. Disease Mangement 2006;9(4):201-9.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Hua 2011 {published data only}
  • Hua TD, Vormfelde SV, Abed MA, Schneider-Rudt H, Sobotta P, Friede T, Chenot JF. Practice nurse-based, individual and video assisted patient education in oral anticoagulation - Protocol of a cluster-randomized controlled trial. BMC Family Practice 2011;12:17.
Smith 2010 {published data only}
  • Smith DE, Borg Xuereb C, Pattison HM, Lip GYH, Lane DA. TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control and outcome of Treatment with warfarin (TREAT). BMC Cardiovascular Disorders 2010;10:21.
Stafford 2011 {published data only}
  • Stafford L, Peterson GM, Bereznicki LRE, Jackson S. A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'role of community pharmacy in post hospital management of patients initiated on warfarin' study. BMC Health Services Research 2011;11:16.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Aikens 2005
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Ansell 2004
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Coehlo-Dantas 2004
  • Coehlo-Dantas G, Thomson BV, Manson JA, Tracy CS, Upshur REG. Patients' perspectives on taking warfarin: qualitative study in family practice. BMC Family Practice 2004;5:15. [DOI: 10.1186/1471-2296-5-15]
Connolly 2008
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Connolly 2009
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Connolly 2011
Dantas 2004
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ESC 2010
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Farmer 2006
Fuller 2004
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  • Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). Circulation 2006;114:257-354.
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Go 2001
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Granger 2011
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Nadar 2003
  • Nadar S, Begum N, Kaur B, Sandhu S, Lip GYH. Patients understanding of anticoagulation therapy in a multiethnic population. Journal of the Royal Society of Medicine 2003;96:175-9.
Neame 2005
NICE 2006
  • National Collaborating Centre for Chronic Conditions. Atrial fibrillation: national clinical guideline for management in primary and secondary care. London: Royal College of Physicians 2006.
NICE 2007
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O'Connor 1995
Patel 2011
Protheroe 2000
  • Protheroe J, Fahey T, Montgomery AA, Peters TJ. The impact of patients' preferences on treatment of atrial fibrillation: observational study of patient based decision analysis. BMJ 2000;320:1380-4.
Rosendaal 1993
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Ruff 2010
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Schulman 2004
Shantsila 2010
Steed 2010
Stewart 2001
Stewart 2004
Tang 2003
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