Self-monitoring and self-management can improve quality of anticoagulant therapy

Clinical question: 
Compared with standard monitoring, how effective are selfmonitoring and self-management of oral anticoagulant therapy?
Bottom line: 
Compared with standard monitoring by a physician, self-monitoring and/or self-management can improve the quality of oral anticoagulant therapy. Self-management alone halved thromboembolic events and mortality rates, with no effect on major bleeds. Self-monitoring alone halved the number of major haemorrhages, but did not significantly reduce the rate of thrombotic events or all-cause mortality.
Caveat: 
Self-monitoring or self-management was not feasible for up to half of the patients requiring anticoagulant therapy. Reasons included patient refusal, exclusion by their GP, and inability to complete training.
Context: 
The introduction of portable monitors (point-of-care devices) for the management of patients on oral anticoagulation therapy allows self-testing by the patient at home. Patients who self-test can either adjust their medication according to a predetermined dose-INR schedule (self-management) or they can call a clinic to be told the appropriate dose adjustment (self-monitoring).
Review CD#: 
CD003839
PEARLS No: 
270
Date: 
June, 2010
Authored by: 
Brian R McAvoy