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To the Editor: The interesting study by Dr Sawicki¹ provides further evidence of the potential value of patient self-management in oral anticoagulation. However, several peculiarities of the study design make the results difficult to extrapolate to patients currently receiving optimal care.

The intervention group, in addition to self-assessment of their prothrombin time and international normalized ratio (INR), had extensive weekly teaching sessions that included topics and issues that could clearly affect future coagulation control (effect of diet, medications). More important, they were instructed in a model of care regarding how to increase or decrease the anticoagulant dosages to achieve target INR values. The algorithm they were taught is not available to the reader. At our ambulatory center, we have been able to see considerable improvement in achieving target INR values by standardizing all physicians' adjustments in dosages with a standard of care algorithm. Was the same model of change in . . . [Full Text of this Article]