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Article
Self-monitoring of oral anticoagulation: A systematic review and meta-analysis
The Lancet (2006)
  • C Heneghan, University of Oxford
  • P Alonso-Coello
  • J M Garcia-Alamino
  • R Perera, University of Oxford
  • E Meats, University of Oxford
  • P P. Glasziou, University of Oxford
Abstract

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.

Keywords
  • self-monitoring,
  • oral anticoagulation,
  • warfarin
Publication Date
February 4, 2006
Publisher Statement
Interim status: Citation only.

Heneghan, C., Alonso-Coello, P., Garcia, J.M., Perera, R., Meats, E. & Glasziou, P. (2006). Self-monitoring of oral anticoagulation: A systematic review and meta-analysis. Lancet, 367(9508), 404-411.

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© Copyright Elsevier, 2006
Citation Information
C Heneghan, P Alonso-Coello, J M Garcia-Alamino, R Perera, et al.. "Self-monitoring of oral anticoagulation: A systematic review and meta-analysis" The Lancet Vol. 367 Iss. 9508 (2006)
Available at: http://works.bepress.com/paul_glasziou/35/