[Portable coagulometers: a systematic review of the evidence on self-management of oral anticoagulant treatment].
OBJECTIVE
We aimed to systematically review the scientific evidence about the use of portable coagulometers for patient's self-management of oral anticoagulant treatment.


METHODS
Systematic review of scientific evidence available from MEDLINE'S, DARE's, HTA-Database's, NHS-EED's and The Cochrane Library' s bibliographic databases, from their origin to March 2003. Randomized control trials (RCT) and Quasi-Experimental trials were selected provided that they compared patients in self-management with patients under usual care. The quality of scientific evidence was elicited using the Scottish Intercollegiate Guideline Network (SIGN) recommendations, whilst efficacy and security were descriptively summarized.


RESULTS
Twelve (7 RCT and 5 quasi-experimental trials) articles were found, and only two of them provided grade A recommendation. Patients under self-management remained the same or more time in the therapeutic range. The incidence of adverse effects in self-management patients was the same or less than that in patients under usual care.


CONCLUSIONS
The quality of the scientific evidence is heterogeneous. For selected patients, patient's self-management is at least as effective and safe as usual care. New oral anticaogulants, which have shown promising results, should be scrutinized for future changes in service provision.
de Solà-Morales Serra
Oriol
O
Agència d'Avaluació de Tecnologia i Recerca Mèdiques (AATRM), Barcelona, Spain. osala@aatrm.catsalut.net
Elorza Ricart
Josep Maria
JM
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001780:Blood Coagulation Tests / Q000295:instrumentation*; D002986:Clinical Trials as Topic; D016903:Drug Monitoring / Q000295:instrumentation*; D006801:Humans; D012648:Self Care
D000925:Anticoagulants