Meta-analysis: Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes

Bloomfield, Hanna E.; Krause, Ange; Greer, Nancy; Taylor, Brent C.; MacDonald, Roderick; Rutks, Indulis; Reddy, Preetham; Wilt, Timothy J

doi:10.7326/0003-4819-154-7-201104050-00005

Cited by 157 publications

(146 citation statements)

References 60 publications

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“…Our findings are in line with those of previously published systematic reviews on self-monitoring using point-of-care devices for the management of anticoagulation therapy, which found that self-monitoring was associated with a significantly lower incidence of thromboembolic events 21,31,33,88,108,[135][136][137] and deaths. 21 …”

Section: Chapter 4 Discussionsupporting

confidence: 82%

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

Sharma

Scotland

Cruickshank

et al. 2015

Health Technol Assess

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This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was commissioned and funded by the HTA programme on behalf of NICE as project number 13/06/01. The protocol was agreed in June 2013. The assessment report began editorial review in December 2013 and was accepted for publication in March 2014. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Departm...

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Section: Chapter 4 Discussionsupporting

confidence: 82%

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

Sharma

Scotland

Cruickshank

et al. 2015

Health Technol Assess

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“…Clinical scores-eg, the HEMORR2HAGES score 69 and the RIETE score 70 (table 4) interactions, restriction of alcohol ingestion, and, in some patients, with use of self-monitoring or even selfmanagement, 71 which remains debated. 72,73 Additionally, large loading doses should be avoided to prevent development of a paradoxical prothrombotic state due to the depletion of protein C, a vitamin K-dependent coagulation inhibitor with a very short half-life. Whether rapid turnaround genetic testing will be clinically useful to guide warfarin dosing remains to be established.…”

Section: Safety Of Anticoagulant Treatmentmentioning

confidence: 99%

Pulmonary embolism and deep vein thrombosis

2012

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Pulmonary embolism is the third most common cause of death from cardiovascular disease after heart attack and stroke. Sequelae occurring after venous thrombo embolism include chronic thromboembolic pulmonary hypertension and post-thrombotic syndrome. Venous thromboembolism and atherothrombosis share common risk factors and the common pathophysiological characteristics of infl ammation, hypercoagulability, and endothelial injury. Clinical probability assessment helps to identify patients with low clinical probability for whom the diagnosis of venous thromboembolism can be excluded solely with a negative result from a plasma D-dimer test. The diagnosis is usually confi rmed with compression ultrasound showing deep vein thrombosis or with chest CT showing pulmonary embolism. Most patients with venous thromboembolism will respond to anticoagulation, which is the foundation of treatment. Patients with pulmonary embolism should undergo risk stratifi cation to establish whether they will benefi t from the addition of advanced treatment, such as thrombolysis or embolectomy. Several novel oral anticoagulant drugs are in development. These drugs, which could replace vitamin K antagonists and heparins in many patients, are prescribed in fi xed doses and do not need any coagulation monitoring in the laboratory. Although rigorous clinical trials have reported the eff ectiveness and safety of pharmacological prevention with low, fi xed doses of anticoagulant drugs, prophylaxis remains underused in patients admitted to hospital at moderate risk and high risk for venous thromboembolism. In this Seminar, we discuss pulmonary embolism and deep vein thrombosis of the legs.

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“…Finally, selftesting of international normalized ratio is feasible, well accepted, and cost-effective. 6 Therefore, we are slow to recommend these newer, more expensive anticoagulant agents. After the publication of our report, we have become aware of postmarketing cases of DILI from rivaroxaban.…”

Section: Use Of Nontraditional Anticoagulants In Portal Vein Thrombosmentioning

confidence: 99%