Self-testing and adjustment of anticoagulant doses lower mortality and thromboembolic events
THURSDAY, April 7 (HealthDay News) -- Patient self-testing (PST), alone or in combination with patient self-management (PSM) of anticoagulant doses, reduces thromboembolic complications and all-cause mortality without increasing major bleeding events, according to a meta-analysis published in the April 5 issue of the Annals of Internal Medicine.
Hanna E. Bloomfield, M.D., M.P.H., from the Minneapolis Veterans Affairs Health Care System, and colleagues conducted a literature review to determine whether outpatients receiving oral anticoagulant therapy for more than three months could use PST, alone or in combination with PSM, to reduce thromboembolic complications and all-cause mortality, without increasing risk for a major bleeding event. The authors identified 22 studies published between 1966 and 2010, which compared 8,413 patients randomly assigned to PSM or PST or to usual care in a physician's office or anticoagulation clinic.
The investigators found that, compared to usual care, patients assigned to the PST or PSM group had a reduced risk of total mortality (Peto odds ratio [OR], 0.74) and major thromboembolism (Peto OR, 0.58), and showed no increase in major bleeding events (Peto OR, 0.89). The strength of evidence was low for mortality and moderate for bleeding and thromboembolism outcomes. Patient satisfaction, quality of life, or both were improved with PST or PSM compared to usual care. In one-half of the trials, fewer than 50 percent of the participants completed the training and agreed to be randomly assigned to a group.
"Our review indicates that, compared with usual clinic care, PST with or without PSM is associated with significantly fewer deaths and thromboembolic events, without any increase in bleeding complications, for a selected group of motivated patients requiring long-term anticoagulation with vitamin K antagonists," the authors write.
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