[Self-management in anticoagulation--a meta-analysis].
BACKGROUND
The aim of anticoagulation treatment is to reach an optimal international normalised ratio (INR) level in which the risk of thrombosis as well as bleeding is minimal. Recently developed methods that allow self-managed control of anticoagulation make more frequent testing possible and may thus represent a better alternative than conventional control.


METHODS
In this meta-analysis, randomized, controlled trials comparing self-management with conventional control with regard to time in therapeutic range and number of bleedings and thromboses were investigated. Eight clinical trials fulfilled the criteria for inclusion, representing about 870 patient-years and 1300 patients.


RESULTS
The difference in time in therapeutic range was on average 10% in favour of self-management. The rate of major and fatal bleedings was 3.5% per patient-years with conventional control, 2.4% per patient-years with self-management. The rate of thrombosis was 3.9% per patient-years with conventional control as against 2.7% with self-management. OddsratioMH for major clinical events was 0.62 (95% CI 0.429, 0.895); p < 0.01.


CONCLUSIONS
This meta-analysis shows that self-managed control of anticoagulation improves safety and efficacy and is probably a better alternative than conventional control for selected groups of patients.
Ødegaard
Kaja Johannson
KJ
k.j.odegaard@studmed.uio.no
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019934:International Normalized Ratio; D012449:Safety; D012646:Self Administration; D012648:Self Care; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin