Dr. Rajabrata Sarkar, chief of vascular surgery at the University of Maryland Medical Center, said that the study results were likely due to the caliber of the hospital.
"I don't think these results are reproducible community wide in America," said Dr. Sarkar, who has many patients taking warfarin. "Not everyone has access to this high quality of care, so the home testing is an excellent alternative for people who have geographic or economic barriers but still have to come into the clinic to get checked."
"So, if the quality of anticoagulation care is lower in a different hospital setting, home testing may have been shown to be a better alternative than the office visit," continued Dolor.
Usually, patients on anticoagulant medication visit their doctor at least once a month to get blood drawn. If the levels are too high or too low, the medication is adjusted.
New treatments are being researched for people on anticoagulant drugs. On Wednesday, the FDA approved dabigatran, an orally active direct thrombin inhibitor, which would not require regular blood monitoring. This could soon be the preferred medication. But, for those who will stay on warfarin, self-monitoring might lead to an easier solution for the drug.
"Effective use of home monitoring makes a whole lot of sense for warfarin," said Dr. Daniel Brotman, associate professor of medicine at Johns Hopkins Hospital. "My recommendation to patients has always been that they should not go to once-monthly check until they're on a stable regimen and their dose hasn't changed during a one or two week period of time. And some patients never get to that point, so a weekly self-check would be good."
A lot of things can affect these levels, said Brotman, including new medicines, change in diet and exercise. Self-tests would allow patients to be more involved and pro-active, much like other home kits for a variety of conditions on the market.
Home tests have become a major part of the healthcare system. Today, a person can walk into a pharmacy and pick up a test to check for pregnancy, UTIs and HIV. Kits for diabetics are available to check their blood sugar levels at home.
Dr. Gerald Bernstein, director of the Diabetes Management Program of the Friedman Diabetes Institute at Beth Israel Medical Center, said that education is important with any self-administered test. At the Friedman Diabetes Institute, diabetes educators are on hand to teach patients how to use their equipment and answer questions about the disease.
"As with all home tests, it's important to know what the quality of the testing equipment is at home," said Bernstein. "I'd want to know the quality of the testing equipment, if it's easy enough to use, and if the results are reliable enough."
Dr. Joanna Cain, the chair of the department of Obstetrics and Gynecology at the Warren Alpert Medical School of Brown University, said she prescribes Coumadin to many of her cancer patients.
"It would make their lives much better if they could test at home so they don't have to schlep in to get their blood drawn all the time," said Cain. "But we as a country have not been very good about supply coverage for the kind of education and health professional support for even things like diabetes, let alone something like this where the dosage change could be significant with a significant impact."
"The self-test is a great idea," continued Cain, "but it has to come hand in hand with training and education that would let me know my patients would be safe."