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Evidence-Based Medicine 2006;11:103; doi:10.1136/ebm.11.4.103
Copyright © 2006 by the BMJ Publishing Group Ltd.
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Therapeutics

Review: self monitoring increases the efficacy and safety of anticoagulant therapy

Heneghan C, Alonso-Coello P, Garcia-Alamino JM, et al. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis. Lancet 2006;367:404–11.[CrossRef][Medline]

Q In patients receiving oral anticoagulant therapy, how do the safety and efficacy of self monitoring compare with management by healthcare professionals?

Clinical impact ratings GP/FP/Primary care ******{star} IM/Ambulatory care ******{star} Internal medicine ******{star} Haematology *****{star}{star}

Key Words: anticoagulants • heparin • warfarin • self administration

The first 150 words of the full text of this article appear below.

METHODS
Formula Data sources Medline, EMBASE/Excerpta Medica, and CINAHL (2005); Cochrane Central Register of Controlled Trials; Cochrane Library (issue 2, 2005); UK National Research Register; Trials Central; bibliographies of retrieved studies; manufacturers of home monitors; and experts in the field.

Formula Study selection and assessment randomised controlled trials (RCTs) that compared self testing (only) or self management (testing and dose adjustment) with management by healthcare professionals (control group) in adults or children who were receiving oral anticoagulation therapy for any indication. 14 RCTs (n = 3049, mean age range 42–75 y) met the selection criteria. Quality assessment of individual trials included randomisation, allocation concealment, blinding of outcome assessors, use of intention to treat analysis, and follow up. In the control group, management was provided by primary care physicians in 8 RCTs and by specialised anticoagulation clinics in 6 RCTs. Duration of the studies ranged from 2 to 24 months.

Formula Outcomes thromboembolic events, major . . . [Full text of this article]

John Spandorfer, MD

Jefferson Medical College, Philadelphia, Pennsylvania, USA






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