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.
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.
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#: 
June, 2010
Authored by: 
Brian R McAvoy