Self-monitoring of oral anticoagulation: a systematic review and meta-analysis
Volume 367, Issue 9508, Pages 404 - 411, 4 February 2006
Dr C Heneghan MRCGP, P Alonso-Coello MD, JM Garcia-Alamino RN, R Perera PhD, E Meats BSc, Prof P Glasziou FRACGP
Near-patient testing has made self-monitoring of anticoagulation with warfarin feasible, and several trials have suggested that such monitoring might be equal to or better than standard monitoring. We did a systematic review and meta-analysis of all randomised controlled trials that assessed the effects of self-monitoring or self-management (self-testing and self-dosage) of anticoagulation compared with standard monitoring.
We identified 14 randomized trials of self-monitoring: pooled estimates showed significant reductions in thromboembolic events and major hemorrhage. Trials of combined self-monitoring and self-adjusted therapy showed significant reductions in thromboembolic events and death.
Self-management improves the quality of oral anticoagulation. Patients capable of self-monitoring have fewer thromboembolic events and lower mortality than those who self-monitor alone. However, self-monitoring is not feasible for all patients, and requires identification and education of suitable candidates.
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