Self-monitoring of oral anticoagulation: a systematic review and meta-analysis.
In: Lancet, Jg. 367 (2006-02-04), Heft 9508, S. 404-411
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academicJournal
Zugriff:
Summary 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. [ABSTRACT FROM AUTHOR]
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Self-monitoring of oral anticoagulation: a systematic review and meta-analysis.
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Autor/in / Beteiligte Person: | Heneghan, C. ; Alonso-Coello, P. ; Garcia-Alamino, J. M. ; Perera, R. ; Meats, E. ; Glasziou, P. |
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Zeitschrift: | Lancet, Jg. 367 (2006-02-04), Heft 9508, S. 404-411 |
Veröffentlichung: | 2006 |
Medientyp: | academicJournal |
ISSN: | 0140-6736 (print) |
DOI: | 10.1016/S0140-6736(06)68139-7 |
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