Self-monitoring and self-management can improve quality of anticoagulant therapy

January 01, 0001

Self-monitoring and self-management can improve quality of anticoagulant therapy

Clinical Question: Compared with standard monitoring, how effective are self-monitoring and self-management of oral anticoagulant therapy?

Bottom line: Compared with standard monitoring by a physician, self-monitoring and/or self-management can improve the quality of oral anticoagulant therapy. Self-management alone halved thromboembolic events and mortality rates, with no effect on major bleeds. Self-monitoring alone halved the number of major haemorrhages, but did not significantly reduce the rate of thrombotic events or all-cause mortality.

Context: Self-monitoring or self-management was not feasible for up to half of the patients requiring anticoagulant therapy. Reasons included patient refusal, exclusion by their GP, and inability to complete training.

Context: The introduction of portable monitors (point-of-care devices) for the management of patients on oral anticoagulation therapy allows self-testing by the patient at home. Patients who self-test can either adjust their medication according to a predetermined dose-INR schedule (self-management) or they can call a clinic to be told the appropriate dose adjustment (self-monitoring).

Cochrane Systematic Review: Garcia-Alamino JM et al. Self-monitoring and self-management of oral anticoagulation. Cochrane Reviews, 2010, Issue 4. Article No. CD003839. DOI: 10.1002/14651858.CD003839.pub2. This review contains 18 studies involving 4723 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 270, June 2010. .
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: B. Blood/Immune Mechanisms. Keywords: anticoagulation, oral, monitoring, self-management
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 2 November 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.