TY  - JOUR
A1  - Heneghan, Carl
A1  - Ward, Alison
A1  - Perera, Rafael
A1  - Bankhead, Clare
A1  - Fuller, Alice
A1  - Stevens, Richard
A1  - Bradford, Kairen
A1  - Tyndel, Sally
A1  - Alonso-Coello, Pablo
A1  - Ansell, Jack
A1  - Beyth, Rebecca
A1  - Bernardo, Artur
A1  - Christensen, Thomas Decker
A1  - Cromheecke, Manon
A1  - Edson, Robert G
A1  - Fitzmaurice, David
A1  - Gadisseur, Alain PA
A1  - Garcia-Alamino, Josep M
A1  - Gardiner, Chris
A1  - Hasenkam, Michael
A1  - Jacobson, Alan
A1  - Kaatz, Scott
A1  - Kamali, Farhad
A1  - Khan, Tayyaba Irfan
A1  - Knight, Eve
A1  - Kortke, Heinrich
A1  - Levi, Marcel
A1  - Matchar, David Bruce
A1  - Menendez-Jandula, Barbara
A1  - Rakovac, Ivo
A1  - Schaefer, Christian
A1  - Siebenhofer, Andrea
A1  - Souto, Juan Carlos
A1  - Sunderji, Rubina
A1  - Gin, Kenneth
A1  - Shalansky, Karen
A1  - Völler, Heinz
A1  - Wagner, Otto
A1  - Zittermann, Armin
T1  - Self-monitoring of oral anticoagulation systematic review and meta-analysis of individual patient data
JF  - The lancet
N2  - Background Uptake of self-testing and self-management of oral coagulation has remained inconsistent, despite good evidence of their effectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a meta-analysis of individual patient data addressing several important gaps in the evidence, including an estimate of the effect on time to death, first major haemorrhage, and thromboembolism.
 Methods We searched Ovid versions of Embase (1980-2009) and Medline (1966-2009), limiting searches to randomised trials with a maximally sensitive strategy. We approached all authors of included trials and requested individual patient data: primary outcomes were time to death, first major haemorrhage, and first thromboembolic event. We did prespecified subgroup analyses according to age, type of control-group care (anticoagulation-clinic care vs primary care), self-testing alone versus self-management, and sex. We analysed patients with mechanical heart valves or atrial fibrillation separately. We used a random-effect model method to calculate pooled hazard ratios and did tests for interaction and heterogeneity, and calculated a time-specific number needed to treat.
 Findings Of 1357 abstracts, we included 11 trials with data for 6417 participants and 12 800 person-years of follow-up. We reported a significant reduction in thromboembolic events in the self-monitoring group (hazard ratio 0.51; 95% CI 0.31-0.85) but not for major haemorrhagic events (0.88, 0.74-1.06) or death (0.82, 0.62-1.09). Participants younger than 55 years showed a striking reduction in thrombotic events (hazard ratio 0.33, 95% CI 0.17-0.66), as did participants with mechanical heart valve (0.52, 0.35-0.77). Analysis of major outcomes in the very elderly (age >= 85 years, n=99) showed no significant adverse effects of the intervention for all outcomes.
 Interpretation Our analysis showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. Patients should also be offered the option to self-manage their disease with suitable health-care support as back-up.
Y1  - 2012
U6  - https://doi.org/10.1016/S0140-6736(11)61294-4
SN  - 0140-6736
VL  - 379
IS  - 9813
SP  - 322
EP  - 334
PB  - Elsevier
CY  - New York
ER  -