Abstracts

Do-it-yourself anticoagulation can be safe and effective

A new meta-analysis has confirmed that many adults can safely monitor their own oral anticoagulation. In pooled analyses, self-monitoring reduced the risk of thrombo-embolism by nearly 50% (hazard ratio 0.51, 95% CI 0.31 - 0.85) when compared with monitoring by doctors in primary care or anticoagulation clinics. Adults who monitored their own international normalised ratio had no more major haemorrhages than controls (0.88, 0.74 - 1.06) and comparable mortality (0.82, 0.62 - 1.09).

In smaller but more detailed analyses, self-monitoring seemed to work best for adults under 55 years (0.33, 0.17 - 0.66) and those with mechanical heart valves. A linked comment says these patients should be given the chance to take their own tests and make the required dose adjustments, because self-testing alone looked less effective than full self-management.

Benefits were less clear-cut for older adults taking warfarin for atrial fibrillation, although the authors found no evidence of serious harm associated with self-monitoring in this group of patients.

They analysed individual patient data from 11 trials but were unable to access data from 10 more. Participants were carefully selected, so self-monitoring won’t be an option for everyone, say the authors. Exclusions included adults with poor cognition and those without the manual dexterity to cope with a finger stick procedure.

Heneghan C, et al. The Lancet. doi:10.1016/S0140-6736(11)61294-4.