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PATIENTS CAPABLE OF SELF-MONITORING THEIR ANTICOAGULATION THERAPY
HAVE SURVIVAL BENEFIT

Patients capable of self-monitoring their warfarin therapy could benefit from a one-third reduction in death from all causes, according to a meta-analysis in this week's issue of The Lancet. However, self-monitoring is not feasible for all patients, and requires identification and education of suitable candidates, state the authors of the study.

Oral anticoagulation agents reduce the likelihood of thrombosis. However, much of their potential is not realised because the treatment is either not used or not used well. The therapeutic range for warfarin is narrow and therefore requires regular testing and appropriate adjustment. Home testing devices allow patients to either self-test and self-adjust treatment, or self-test and contact a clinic to receive the appropriate dose adjustment. Self-monitoring can be more convenient for patients, however, there has been no reliable clinical-outcome data to lend support to its use until now.

Carl Heneghan (University of Oxford, UK) and colleagues pooled data from 14 randomised trials of self-monitoring. They found that self-monitoring led to a 55% relative reduction in thromboembolic events, a 39% relative reduction on all-cause mortality, and 35% relative reduction in major haemorrhage when compared with those who did not self-monitor. They also found that patients who could self-manage (self test and self-dose) had fewer thromboembolic events and lower mortality than those who self-monitor alone.

Dr Heneghan states: "Self-monitoring can improve the quality of oral anticoagulation therapy, with patients more frequently in the therapeutic range, while improving benefits and decreasing harms."

Dr Carl Heneghan, Department of Primary Health Care, University of Oxford

Published with kind permission of 'The Lancet': Lancet 2006; 367: 404-11. See Articles page 412