Self-monitoring of anticoagulation cuts mortality
Cristina Pedrazzini/Science Photo Library
Self-testing of anticoagulation reduces death rates |
Self-monitoring of oral anticoagulants leads to fewer thromboembolic events and lower mortality than with standard monitoring, according to a paper published in The
Lancet this week (2006;367:404).
Carl Heneghan, University of Oxford, and colleagues conducted a meta-analysis
of 14 randomised controlled trials involving 3,049 patients. They looked
at trials that assessed the effects of self-monitoring (self-testing)
or self-management (self-testing plus self-dosage) of anticoagulation
compared with standard monitoring.
Self-monitoring was found to lead to a 55 per cent relative reduction
in thromboembolic events, a 39 per cent relative reduction in all-cause
mortality and a 35 per cent relative reduction in major haemorrhage.
Self-management resulted in a greater reduction in thromboembolic events
(73 per cent) and death (63 per cent) but less reduction in major haemorrhage
(7 per cent). No difference in minor haemorrhage was noted. Eleven of
the studies reported improvements in international normalised ratio in
the self-monitoring groups, six of which were significant, say the researchers.
“Self-monitoring can improve the quality of oral anticoagulation
therapy, with patients more frequently in the therapeutic range, while
improving
benefits and decreasing harm,” the researchers commented.
They add, however, that although self-monitoring offers independence
and freedom of travel to selected patients, it is not feasible for all,
and requires identification and education of suitable candidates. Intrinsic
limitations include the reluctance of patients to participate and the
high cost of the test strips used. |
The
Pharmaceutical Journal
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