Comparing Self-Management of Oral Anticoagulant Therapy with Clinic Management

Abstract

Compared with conventional management by an anticoagulation clinic, self-management of oral anticoagulant treatment achieved a similar level of control. Of note, major complications and minor hemorrhages were less common in the self-management group.

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy

“…We hypothesize it is these preferences that account for the high drop-out rate experienced (up to 20%) in previous self-management trials. 4,7 Subsequent economic analysis should stratify cost-effectiveness by indication and by preference for using the point-ofcare device. This will aid in informing clinicians and decision-makers on which patients are most likely to benefit from self-management.…”

“…4 Several published trials have compared self-management with physician management or management in an anticoagulation clinic. [4][5][6][7][8][9][10][11][12][13] It has been found that patients who self-manage check their INR more frequently and are able to maintain a greater proportion of INRs within the therapeutic range compared with those whose therapy is monitored by a physician or in an anticoagulation clinic. [11][12][13] The results of a recent meta-analysis showed a significant reduction in thromboembolic events (odds ratio [OR] 0.45), major hemorrhagic events (OR 0.65) and all-cause mortality (OR 0.61) for those using a self-management or self-test strategy.…”

The clinical effectiveness and cost-effectiveness of point-of-care tests (CoaguChek system, INRatio2 PT/INR monitor and ProTime Microcoagulation system) for the self-monitoring of the coagulation status of people receiving long-term vitamin K antagonist therapy, compared with standard UK practice: systematic review and economic evaluation

“…55,57,[61][62][63][64][65] In 11 trials, the randomisation process proved to be adequate but no information was provided on the way in which participants were allocated to the study interventions. 58,60,[66][67][68][69][70][71][72][73][74] One trial 75 reported adequate details about the generation of the random sequence but failed to conceal the allocation of participants to study interventions.…”

“…Six of them had limited missing data with similar reasons for discontinuation across intervention groups. 59,69,72,74,76,79 Seven trials relied on an intention-to-treat approach and all dropouts were fully accounted for in the statistical analyses, 55,61,[63][64][65]71,75 while the other four reported no missing data. 58,60,62,78 Eight of the 26 included trials were at high risk of attrition bias, with more than 5% dropout rate and with missing data not appropriately tackled.…”

“…Seven trials blinded the outcomes assessor (statistician or clinical outcome assessor). 55,58,[61][62][63]72,77 In six trials, neither the participants nor the personnel involved in delivering the interventions were blinded. 60,65,66,71,74,75 One trial 70 was described as 'double blinded' but no further information was given.…”