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Evidence summaries

Self-Monitoring and Self-Management of Oral Anticoagulation

Self-monitoring and self-management of oral anticoagulation appears to reduce thromboembolic events, and self-management also all-cause mortality compared to standard care. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

Summary

A Cochrane review[Abstract] 1 included 28 studies with a total of 8 950 subjects. Patients who self-test can either adjust their medication dose according to a pre-determined dose-INR schedule (self-management) or they can call a clinic to be told the appropriate dose adjustment (self-monitoring). Compared to standard therapy, self-monitoring or self-management of oral anticoagulation led to a significant 50% reduction in thromboembolism but no reduction in all-cause mortality. However, trials of self-management led to a significant reduction in all-cause mortality. In those groups that self-managed the effect for thromboembolic events was larger than in the groups that self-monitored (table T1) Self-monitoring or self-management did not reduce major haemorrhage (RR 0.95, 95% CI, 0.80 to 1.12; 20 studies, n=8018) or minor haemorrhage (RR 0.97, 95% CI 0.67 to 1.41; 13 studies, n=5 365).

Self-monitoring or self-management of oral anticoagulation vs. standard care

Outcome and interventionRR (95% CI)Assumed risk - standard careCorresponding risk - intervention (95% CI)Participants (studies)
Thromboembolic events
Self-monitoring or self-managementRR 0.58 (0.45 to 0.74)35 per 100021 per 1000 (16 to 26)7 594(18 studies)
Self-monitoringRR 0.69(0.49 to 0.97)35 per 100024 per 1000(17 to 34)4 097(7 studies)
Self-managementRR 0.47(0.31 to 0.70)36 per 100017 per 1000(12 to 25)3 497(11 studies)
All-cause mortality
Self-monitoring or self-managementRR 0.85(0.71 to 1.01)64 per 100054 per 1000(45 to 64)6 358(11 studies)
Self-monitoringRR 0.94(0.78 to 1.15)90 per 100085 per 1000(70 to 104)3 300(3 studies)
Self-managementRR 0.55(0.36 to 0.84)33 per 100018 per 1000(12 to 28)3 058(8 studies)

Clinical comments

Self-monitoring and self-management are not feasible for all patients, which requires the identification and education of suitable patients.

    References

    • Heneghan CJ, Garcia-Alamino JM, Spencer EA et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Database Syst Rev 2016;(7):CD003839 [PubMed].

Primary/Secondary Keywords