Self-monitoring of oral anticoagulation: a systematic review and meta-analysis.
BACKGROUND: 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 asse...
| Váldodahkkit: | , , , , , |
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| Materiálatiipa: | Journal article |
| Giella: | English |
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2006
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| _version_ | 1826266700272631808 |
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| author | Heneghan, C Alonso-Coello, P Garcia-Alamino, J Perera, R Meats, E Glasziou, P |
| author_facet | Heneghan, C Alonso-Coello, P Garcia-Alamino, J Perera, R Meats, E Glasziou, P |
| author_sort | Heneghan, C |
| collection | OXFORD |
| description | BACKGROUND: 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. METHODS: We searched the Cochrane Register of Controlled Trials, MEDLINE, EMBASE to April 2005, and contacted manufacturers and authors of relevant studies. Outcomes analysed were: major haemorrhage, thromboembolic events, death, tests in range, minor haemorrhage, frequency of testing, and feasibility of self-monitoring. FINDINGS: We identified 14 randomised trials of self-monitoring: pooled estimates showed significant reductions in thromboembolic events (odds ratio 0.45, 95% CI 0.30-0.68), all-cause mortality (0.61, 0.38-0.98), and major haemorrhage (0.65, 0.42-0.99). Trials of combined self-monitoring and self-adjusted therapy showed significant reductions in thromboembolic events (0.27, 0.12-0.59) and death (0.37, 0.16-0.85), but not major haemorrhage (0.93, 0.42-2.05). No difference was noted in minor haemorrhage. 11 trials reported improvements in the mean proportion of international normalisation ratios in range. INTERPRETATION: Self-management improves the quality of oral anticoagulation. Patients capable of self-monitoring and self-adjusting therapy 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. |
| first_indexed | 2024-03-06T20:42:56Z |
| format | Journal article |
| id | oxford-uuid:34dcba1d-af9f-482a-9aa6-922b3a0ea9e2 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T20:42:56Z |
| publishDate | 2006 |
| record_format | dspace |
| spelling | oxford-uuid:34dcba1d-af9f-482a-9aa6-922b3a0ea9e22022-03-26T13:28:49ZSelf-monitoring of oral anticoagulation: a systematic review and meta-analysis.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:34dcba1d-af9f-482a-9aa6-922b3a0ea9e2EnglishSymplectic Elements at Oxford2006Heneghan, CAlonso-Coello, PGarcia-Alamino, JPerera, RMeats, EGlasziou, PBACKGROUND: 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. METHODS: We searched the Cochrane Register of Controlled Trials, MEDLINE, EMBASE to April 2005, and contacted manufacturers and authors of relevant studies. Outcomes analysed were: major haemorrhage, thromboembolic events, death, tests in range, minor haemorrhage, frequency of testing, and feasibility of self-monitoring. FINDINGS: We identified 14 randomised trials of self-monitoring: pooled estimates showed significant reductions in thromboembolic events (odds ratio 0.45, 95% CI 0.30-0.68), all-cause mortality (0.61, 0.38-0.98), and major haemorrhage (0.65, 0.42-0.99). Trials of combined self-monitoring and self-adjusted therapy showed significant reductions in thromboembolic events (0.27, 0.12-0.59) and death (0.37, 0.16-0.85), but not major haemorrhage (0.93, 0.42-2.05). No difference was noted in minor haemorrhage. 11 trials reported improvements in the mean proportion of international normalisation ratios in range. INTERPRETATION: Self-management improves the quality of oral anticoagulation. Patients capable of self-monitoring and self-adjusting therapy 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. |
| spellingShingle | Heneghan, C Alonso-Coello, P Garcia-Alamino, J Perera, R Meats, E Glasziou, P Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. |
| title | Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. |
| title_full | Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. |
| title_fullStr | Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. |
| title_full_unstemmed | Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. |
| title_short | Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. |
| title_sort | self monitoring of oral anticoagulation a systematic review and meta analysis |
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