Anticoagulant Self-Monitoring Safe Option for Suitable Patients

Self-monitoring, self-management associated with significant reduction in thromboembolic events

THURSDAY, Dec. 1 (HealthDay News) -- Self-monitoring and self-management of oral coagulation is associated with a significant reduction in thromboembolic events and is a safe option for suitable patients of all ages, according to a review published online Dec. 1 in The Lancet.

Carl Heneghan, D.Phil., from Oxford University in the United Kingdom, and colleagues reviewed available literature to assess the value of self-monitoring of oral anticoagulation, including an estimate of the effect on time to death, first major hemorrhage, and thromboembolism. Individual patient data were collected from authors of the 11 randomized trials that met the inclusion criteria, and comprised 6,417 participants and 12,800 person-years of follow-up. The time to death, first major hemorrhage, and first thromboembolic event were the primary outcomes. Prespecified subgroup analyses were conducted according to age, type of control-group care, self-testing alone versus self-management, and gender. Patients with mechanical heart valves or atrial fibrillation were assessed separately. Pooled hazard ratios were calculated using the random-effect model method, and interaction and heterogeneity, and time-specific number needed to treat were also assessed.

The investigators found that, in the self-monitoring group, there was a significant reduction in thromboembolic events (hazard ratio [HR], 0.51), but not major hemorrhagic events or death. There was a significant reduction in thrombotic events in participants younger than 55 years (HR, 0.33) and those with a mechanical heart valve (HR, 0.52). In an analysis of the very elderly (85 years or older), there were no significant adverse effects of the intervention for all outcomes.

"Self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages," the authors write.

Several authors disclosed financial ties to the pharmaceutical and biomedical industries.

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