Self-monitoring of oral anticoagulation: A systematic review and meta-analysis

C Heneghan, P Alonso-Coello, JM Garcia-Alamino, R Perera, E Meats, P Glasziou

Research output: Contribution to journalReview articleResearchpeer-review

212 Citations (Scopus)

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% Cl 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.

Original languageEnglish
Pages (from-to)404-411
Number of pages8
JournalThe Lancet
Volume367
Issue number9508
DOIs
Publication statusPublished - 4 Feb 2006
Externally publishedYes

Cite this

Heneghan, C., Alonso-Coello, P., Garcia-Alamino, JM., Perera, R., Meats, E., & Glasziou, P. (2006). Self-monitoring of oral anticoagulation: A systematic review and meta-analysis. The Lancet, 367(9508), 404-411. https://doi.org/10.1016/S0140-6736(11)61294-4
Heneghan, C ; Alonso-Coello, P ; Garcia-Alamino, JM ; Perera, R ; Meats, E ; Glasziou, P. / Self-monitoring of oral anticoagulation : A systematic review and meta-analysis. In: The Lancet. 2006 ; Vol. 367, No. 9508. pp. 404-411.
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Heneghan, C, Alonso-Coello, P, Garcia-Alamino, JM, Perera, R, Meats, E & Glasziou, P 2006, 'Self-monitoring of oral anticoagulation: A systematic review and meta-analysis' The Lancet, vol. 367, no. 9508, pp. 404-411. https://doi.org/10.1016/S0140-6736(11)61294-4

Self-monitoring of oral anticoagulation : A systematic review and meta-analysis. / Heneghan, C; Alonso-Coello, P; Garcia-Alamino, JM; Perera, R; Meats, E; Glasziou, P.

In: The Lancet, Vol. 367, No. 9508, 04.02.2006, p. 404-411.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Self-monitoring of oral anticoagulation

T2 - A systematic review and meta-analysis

AU - Heneghan, C

AU - Alonso-Coello, P

AU - Garcia-Alamino, JM

AU - Perera, R

AU - Meats, E

AU - Glasziou, P

PY - 2006/2/4

Y1 - 2006/2/4

N2 - 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% Cl 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.

AB - 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% Cl 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.

U2 - 10.1016/S0140-6736(11)61294-4

DO - 10.1016/S0140-6736(11)61294-4

M3 - Review article

VL - 367

SP - 404

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JO - Lancet

JF - Lancet

SN - 0140-6736

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ER -

Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P. Self-monitoring of oral anticoagulation: A systematic review and meta-analysis. The Lancet. 2006 Feb 4;367(9508):404-411. https://doi.org/10.1016/S0140-6736(11)61294-4