Self-management Of Anticoagulation Research Articles

A Research Protocol for Developing and Validating the PERSONAE Scale: Assessing Preparedness for Self-Management of Oral Anticoagulation in Adult Patients (Preprint)

A Research Protocol for Developing and Validating the PERSONAE Scale: Assessing Preparedness for Self-Management of Oral Anticoagulation in Adult Patients (Preprint)

An Analysis of Perceived and Actual Anticoagulant Knowledge among Independent Pharmacy Patients.

Deficits in knowledge of parameters surrounding anticoagulant therapy administration carry substantial risks for patient harm. Patients prescribed anticoagulants may overestimate their knowledge of anticoagulant use principles. The purpose of this study was to analyze independent pharmacy patients' perceived versus actual knowledge of their anticoagulation therapies. A 15-item survey across a dual-site pharmacy location evaluated patients' confidence in their understanding of anticoagulant prescribing parameters and their awareness of measures to take to safeguard anticoagulant therapy routines. A pharmacist reviewed patient responses to survey items referencing actual understanding of anticoagulant therapies at the conclusion of the survey. Data analyses occurred by gender, age, ethnicity, location, living situation, self-management of anticoagulants, patient perception of anticoagulant safety, and reported receipt of anticoagulant education. Linear regressions were used for statistical analyses, with significance set at p<.05. During the span of three months, 45 patients, 20 females and 25 males, completed the survey. Perceived anticoagulant knowledge did not differ significantly by demographics. Actual anticoagulant knowledge declined by over 20% between age groups 60-69 and 80-89 years old. African Americans displayed 10% lower actual anticoagulant knowledge than Caucasian Americans. This study revealed gaps in knowledge of anticoagulants among patients at an independent pharmacy. An appeal remains for more strategies to assist with knowledge of anticoagulant regimens. Healthcare institutions should continue to incorporate programs geared towards ongoing anticoagulant education, such as question and answer sessions, along with peer support mediums that foster optimal outcomes.

Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: clinical outcomes in a single centre cohort after long-term follow-up

BackgroundPatient self-management (PSM) of vitamin K antagonists (VKA) seems a very promising model of care for oral anticoagulation in terms of efficacy and safety. In comparison with other management models of VKA therapy, the number of scientific publications supporting the advantages of PSM is more limited. Currently, most of the scarce information comes from randomized clinical trials. Moreover, a small number of studies have assessed PSM of VKA therapy in real life conditions.MethodsWe analyzed clinical outcomes of 927 patients in a single center (6018.6 patient-years of follow-up). Recruitment took place between 2002 and 2017. All patients followed a structured training program, conducted by specialized nurses.ResultsFifty percent of individuals had a mechanical heart valve (MHV), 23% suffered from recurrent venous thromboembolism (VTE) or high-risk thrombophilia, and 13% received VKA therapy because of atrial fibrillation (AF). Median follow-up was 6.5 years (range 0.1–15.97 years), median age was 58.1 years (IQR 48–65.9) and 46.5% were women. The incidence of major complications (either hemorrhagic or thromboembolic) was 1.87% patient-years (pt-ys) with a 95% CI of 1.54–2.27. The incidence of major thromboembolic events was 0.86% pt-ys (95% CI 0.64–1.13) and that of major hemorrhagic events was 1.01% pt-ys (95% CI 0.77–1.31). The incidence of intracranial bleeding was 0.22% pt-ys (95% CI 0.12–0.38). In terms of clinical indication for VKA therapy, the incidence of total major complications was 2.4% pt-ys, 2.0% pt-ys, 0.9% pt-ys and 1.34% pt-ys for MHV, AF, VTE and other (including valvulopathies and myocardiopathies), respectively. Clinical outcomes were worse in patients with multiple comorbidities, previous major complications during conventional VKA therapy, and in older individuals. The percentage of time in therapeutic range (TTR) was available in 861 (93%) patients. Overall, the mean (SD) of TTR was 63.6 ± 13.4%, being higher in men (66.2 ± 13.1%) than women (60.6 ± 13.2%), p < 0.05.ConclusionsIn terms of clinically relevant outcomes (incidence of major complications and mortality), PSM in real life setting seems to be a very good alternative in properly trained patients.

Long-term effectiveness and safety of self-management of oral anticoagulants in real-world settings

BackgroundThe patient self-management (PSM) is an effective approach for controlling the international normalized ratio, INR, within the therapeutic range. Nevertheless, most of the literature derives from randomized clinical trials, and no from routine clinical practice. The main objective of the present study was to evaluate long-term effectiveness and safety of PSM of oral anticoagulants (OACs) in real-world settings.MethodsThis prospective cohort study involved 808 patients who were trained for PSM between July 2009 and March 2012, and followed-up for a maximum observational period of 5 years. The follow-up consisted of a visit to the physician every 6 months. All patients used the same type of portable coagulometer, able to store digitally up to 100 INR measurements. Effectiveness outcomes included the percentage of patients within the therapeutic range, the time within therapeutic range (TTR), and the evolution of the TTR over 365 days of follow-up. Long-term safety profile of PSM included the incidence of all-cause deaths and complications (thromboembolic or hemorrhagic) reported between July 2009 and June 2014, and the time to event.ResultsThe median follow-up was 3.3 years. The percentage of patients within therapeutic INR target range was 67.5%. The median TTR was 71.5%. The TTR increased over the follow-up period, either overall and regarding target INR. All-cause mortality was 2.4 per 100 patient-years (59 cases). The thromboembolic event rate was 0.9 per 100 patient-years (24 cases). The rate of major hemorrhages was 0.45 per 100 patient-years. Patients who drop out the PSM to perform the conventional management had greater rates of complications: 2.4, 1.8, and 3.4 per 100 patient-years for thromboembolic complications, major hemorrhagic events, and mortality, respectively.ConclusionsThe PSM of OACs is effective for maintaining patients within the INR therapeutic range for a long period of time in routine clinical practice. Results of the present study suggest that its effectiveness is at least comparable to the conventional management. Moreover, it seems safe in real-world settings, by preventing all-cause mortality, and thromboembolic and major hemorrhagic complications.Trial registrationThis study was not a trial, thus registration was not required.

DTB Select: 10 | October 2016

Updated competency framework for all prescribers ● The risks of under-prescribing in older patients ● Self-monitoring and self-management of oral anticoagulation ● Role of sunscreen in preventing basal cell and...

Predictors of anticoagulation quality in 15834 patients performing patient self-management of oral anticoagulation with vitamin K antagonists in real-life practice: a survey of the International Self-Monitoring Association of Orally Anticoagulated Patients.

Although patient self-management (PSM) of oral anticoagulation with vitamin K antagonists is recommended for patients requiring long-term anticoagulation, important aspects are still unclear. Using data from a large international survey (n=15834; median age 72years; 30·1% female), we studied predictors of poor anticoagulation control (percentage of International Normalized Ratio values within therapeutic range below 75%) and developed a simple prediction model. The following variables were identified as risk factors for poor anticoagulation control and included in the final model: higher intensity of therapeutic range (odds ratio [OR] on every level 1·9; 95% confidence interval [CI] 1·8-2·0), long intervals between measurements (>14d; 1·5; 95% CI 1·3-1·7), female sex (OR 1·3; 95% CI 1·2-1·4), and management other than PSM (OR 1·4; 95% CI 1·2-1·6). At a threshold of 0·2 (at least one variable present), the model predicted poor anticoagulation control with a sensitivity of 85·3% (95% CI: 84·0, 86·4) and a specificity of 28·5% (27·6, 29·5). The area under the receiver operated characteristic curve was 0·65. Using the proposed prediction model, physicians will be able to identify patients with a low chance of performing well, considering additional training, regular follow-up, or adjustment of therapeutic ranges.

Self-monitoring and self-management of oral anticoagulation.

The introduction of point-of-care devices for the management of patients on oral anticoagulation allows self-testing by the patient at home. Patients who self-test can eitheradjust their medication according to a pre-determined dose-INR (international normalized ratio) schedule (self-management), or they can call a clinic to be told the appropriate dose adjustment (self-monitoring). Increasing evidence suggests self-testing of oral anticoagulant therapy is equal to or better than standard monitoring. This is an updated version of the original review published in 2010. To evaluate the effects on thrombotic events, major haemorrhages, and all-cause mortality of self-monitoring or self-management of oral anticoagulant therapy compared to standard monitoring. For this review update, we re-ran the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 6, the Cochrane Library, MEDLINE (Ovid, 1946 to June week 4 2015), Embase (Ovid, 1980 to 2015 week 27) on 1 July 2015. We checked bibliographies and contacted manufacturers and authors of relevant studies. We did not apply any language restrictions . Outcomes analysed were thromboembolic events, mortality, major haemorrhage, minor haemorrhage, tests in therapeutic range, frequency of testing, and feasibility of self-monitoring and self-management. Review authors independently extracted data and we used a fixed-effect model with the Mantzel-Haenzel method to calculate the pooled risk ratio (RR) and Peto's method to verify the results for uncommon outcomes.We examined heterogeneity amongst studies with the Chi(2) and I(2) statistics and used GRADE methodology to assess the quality of evidence. We identified 28 randomised trials including 8950 participants (newly incorporated in this update: 10 trials including 4227 participants). The overall quality of the evidence was generally low to moderate. Pooled estimates showed a reduction in thromboembolic events (RR 0.58, 95% CI 0.45 to 0.75; participants = 7594; studies = 18; moderate quality of evidence). Both, trials of self-management or self-monitoring showed reductions in thromboembolic events (RR 0.47, 95% CI 0.31 to 0.70; participants = 3497; studies = 11) and (RR 0.69, 95% CI 0.49 to 0.97; participants = 4097; studies = 7), respectively; the quality of evidence for both interventions was moderate. No reduction in all-cause mortality was found (RR 0.85, 95% CI 0.71 to 1.01; participants = 6358; studies = 11; moderate quality of evidence). While self-management caused a reduction in all-cause mortality (RR 0.55, 95% CI 0.36 to 0.84; participants = 3058; studies = 8); self-monitoring did not (RR 0.94, 95% CI 0.78 to 1.15; participants = 3300; studies = 3); the quality of evidence for both interventions was moderate. In 20 trials (8018 participants) self-monitoring or self-management did not reduce major haemorrhage (RR 0.95, 95% CI, 0.80 to 1.12; moderate quality of evidence). There was no significant difference found for minor haemorrhage (RR 0.97, 95% CI 0.67 to 1.41; participants = 5365; studies = 13). The quality of evidence was graded as low because of serious risk of bias and substantial heterogeneity (I(2) = 82%). Participants who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy. Thromboembolic events were reduced, for both those self-monitoring or self-managing oral anticoagulation therapy. A reduction in all-cause mortality was observed in trials of self-management but not in self-monitoring, with no effects on major haemorrhage.

Home management of INR in the public health system: feasibility of self-management of oral anticoagulation and long-term performance of individual POC devices in determining INR.

The home prothrombin time/international normalized ratio (PT/INR) self-management could be convenient for patients, enhancing treatment compliance and improving the quality of the oral anticoagulation. However, patient self-management (PSM) of oral anticoagulation may not be feasible for up to half of the patients due to cognitive or educational issues. In the present study, we aimed to evaluate the feasibility of a PSM program in a public health medical center that provides care for low-income patients. We also aimed to determine the accuracy of individual point-of-care devices (CoaguChek XS(®)) during long-term of home manipulation. Patients' time-in-therapeutic range (TTR) and perception of quality of life, were evaluated at scheduled study-visits to the center. Additionally, the accuracy of individual CoaguChek XS(®) was evaluated in comparison to the standard automated coagulometer at scheduled study-visits to the center. Twenty-five patients were included in the PSM program. The median TTR of patients was 75% before inclusion, 72% at 3months, 75% at 6months and 100% at 12months after the beginning of self-management (P=0.14).The median DASS scores were 64, 63, 61.5 and 71.5 before inclusion and at 3, 6 and 12months, respectively (P=0.09). One hundred paired INR values were obtained. Correlation between INR values delivered by individual CoaguChek XS(®) and the automated coagulometer was 94% and the mean result bias was 0.07 INR units. The coefficient of correlation and the mean bias between methods was stable during 24months of follow-up. The present study suggests that PSM is feasible for patients treated in the public health system and that the results delivered by CoaguChek XS(®) have long-term reliability.

Patient self-testing and self-management of oral anticoagulation with vitamin K antagonists: guidance from the British Committee for Standards in Haematology.

Ian Jennings, Dianne Kitchen, David Keeling, David Fitzmaurice and Carl Heneghan on behalf of the BCSH Committee UK NEQAS (Blood Coagulation), Sheffield, Oxford University Hospitals, Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, The University of Birmingham, Primary Care Clinical Sciences, Edgbaston, Birmingham, and Department of Primary Care Health Sciences, Oxford University, Oxford, UK

Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.

Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2–12.8 years). Median age at the time of training was 54.2 years (range 18.2–85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1–1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6–3.7; p<0.001), patients>50 years of age (2.0; 1.6–2.6; p<0.001), and men (1.6; 1.2–2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2–0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9–1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.

Self-management of oral anticoagulation.

Properly dosed oral anticoagulation effectively prevents thromboembolic events. It is unclear whether adult patients with an indication for long-term oral anticoagulation can benefit from self-management in terms of patient-oriented endpoints and improved coagulation values. We selectively searched the Medline database for high-quality systematic reviews based on randomized controlled trials of self-measurement or self-management of oral anticoagulation, compared to standard treatment. We identified eight review articles based on overlapping sets of ran - domized clinical trials. In all of these systematic reviews, patients who performed self-measurement or self-management had a 40% to 50% lower rate of thromboembolic events; in six of them, the mortality was also significantly lower, by 30% to 50%. Subgroup analysis revealed that these effects were present exclusively in patients who performed self-management, and not in those who only performed self-measurement. None of the review articles revealed any difference in the frequency of severe hemorrhagic events. Quality of life and patient satisfaction were rated in five reviews, which, however, used different instruments, with the result that no clear conclusions could be drawn. All of the review articles documented an improvement in coagulation values, but information on statistical significance was mostly lacking. Adults with an indication for long-term oral anticoagulation benefit from self-management, as compared to standard treatment with management of dosing by a physician. A limitation of this study is that the multiple review articles on which it is based were largely analyses of the same group of clinical trials.

Is home warfarin self-management effective? Results of the randomised Self-Management of Anticoagulation Research Trial

AimsThe Warfarin Self-Management Anticoagulation Research Trial (Warfarin SMART) was designed to determine whether patients self-managing warfarin (PSM) using the CoaguChek device and a dosing algorithm developed for the trial could keep the INR (International Normalised Ratio) test in target range at least as often as patients managed by usual care by the family doctor or hospital clinic. Methods and results310 patients were randomly assigned to PSM or usual care. The PSM group was trained to perform home INR testing and warfarin dosing using a validated ColourChart algorithm. The primary endpoint was the proportion of times over 12months that a monthly, blinded “outcome INR test”, measured in a central laboratory, was outside the patient's target therapeutic range.The rate of out-of-range outcome INRs was lower in PSM, and non-inferior to the usual care group (PSM: 36% vs. usual care: 41%, P<0.001 for non-inferiority; P=0.08 for superiority in closed-loop testing). The deviations from the patient's midpoint of target INR range (P=0.02) and number of extreme INRs (P=0.03) were significantly less in the PSM group than the usual-care group. There was no significant difference between groups in rates of bleeding or thrombotic adverse events. ConclusionPatient self-management performed at least as well as usual care in maintaining the INR within the target range, without any safety concerns. This treatment modality for the long-term use of warfarin has the potential to change current local and international practice.

Congenial Multiple Imputation and Matched Pairs Models for Square Tables: An Example of patients’ self-management

Experimental studies often measure an individual’s quality of life before and after an intervention, with the data organized into a square table and analyzed using matched pair modeling. However, it is not unusual to find missing data in either round (i.e., before and/or after) of such studies and the use of multiple imputations with matched-pair modeling remains relatively unreported in the applied statistics literature. In this paper we introduce an approach which maintains dependency of responses over time and makes a match between the imputer and the analyst. We use ‘before’ and ‘after’ quality-of-life data from a randomized controlled trial to demonstrate how multiple imputation and matched-pair modeling can be congenially combined, avoiding a possible mismatch of imputation and analyses, and to derive a properly consolidated analysis of the quality-of-life data. We illustrate this strategy with a real-life example of one item from a quality-of-life study that evaluates the effectiveness of patients’ self-management of anticoagulation versus standard care as part of a randomized controlled trial.

Point-of-care INR coagulometers for self-management of oral anticoagulation: primary care diagnostic technology update

Devices to measure international normalised ratio (INR) are intended for both professional use and patient self-testing to monitor oral anticoagulant therapy. INR is a standardised measurement of the prothrombin time, which is the time it takes blood to clot after addition of tissue factor. Point-of-care (POC) INR testing within primary care settings eliminates delays in waiting for the result of prothrombin time measurement to be processed by the hospital laboratory, and the subsequent delay in adjustment of anti-coagulation dosing. It also avoids the need to attend hospital anticoagulation clinics. ### Clinical Question In patients who require long-term anticoagulation treatment, how accurate and effective is self-management using a home monitoring device for INR, compared to standard practice? The POC devices use electrochemical methods or function by drawing a precise amount of blood into a micro-channel and detect clot formation when the blood movement decreases below a predetermined rate. Currently there are three coagulometers on the market which are suitable for self-testing as they use capillary whole blood obtained from a finger prick. The measuring ranges of these devices vary slightly: INR of 0.6 to 8.0 for CoaguChek® XS (Roche Diagnostics), 0.8 to 8.0 for INRatio® (Hemosense), and 0.8 to 9.9 for ProTime®/ProTime 3 (International Technidyne Corporation). The sample volume required is very small (15–30 µL) with few user dependent steps. The results are typically available in less than 5 minutes.1 Patients requiring long-term anticoagulation therapy, for atrial fibrillation, venous thromboembolism, prosthetic heart valves, or myocardial infarction and a number of pro-thrombotic conditions. Oral anticoagulation …

Self-management of oral anticoagulation in elderly patients – Effects on treatment-related Quality of Life

Background – rationale for studyIn elderly patients, long-term self-management of oral anticoagulation has been shown to reduce the number of major thromboembolic and bleeding complications and improve the quality of oral anticoagulation (OAC) control compared to routine care for a mean follow-up period of three years. This article presents the results of the predefined secondary endpoint treatment-related quality of life (QoL). Methods and ResultsThe effect of self-management on five aspects of QoL was evaluated in comparison with routine care. A validated questionnaire specifically designed for patients receiving OAC was used. The evaluation was possible for 141 patients, comprising 90% of surviving patients on OAC.At baseline, all patients had high scores for the following QoL-aspects: general treatment satisfaction, self-efficacy, daily hassles and strained social network. A high proportion of patients in both groups explicitly reported high distress, indicating that general psychological distress seems to be of particular concern in this population. After about 3years of follow-up, patients performing self-management showed a significantly greater improvement in general treatment satisfaction than controls (median score increase [25th percentile, 75th percentile]: 0.9 [0.0, 1.6] vs. 0.0 [−0.2, 0.6], p=0.002; scale 1–6). Changes in general psychological distress, self-efficacy, daily hassles and strained social network were not significant. ConclusionTreatment related quality of life in elderly patients performing self-management of OAC was similar as for patients in routine care setting, with a tendency of higher general treatment satisfaction, after three years of follow up.

Invited Commentary

Invited Commentary

Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data

Uptake of self-testing and self-management of oral anticoagulation [corrected] 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. 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. 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. 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. UK National Institute for Health Research (NIHR) Technology Assessment Programme, UK NIHR National School for Primary Care Research.

Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes

Letters6 September 2011Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical OutcomesAndrea Siebenhofer, MD, Klaus Jeitler, MD, and Ivo Rakovac, PhDAndrea Siebenhofer, MDFrom Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Search for more papers by this author, Klaus Jeitler, MDFrom Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Search for more papers by this author, and Ivo Rakovac, PhDFrom Institute of General Practice, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria; and Institute for Biomedicine and Health Sciences, Joanneum Research, 8010 Graz, Austria.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-5-201109060-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We found the recent article by Bloomfield and colleagues (1) very interesting. Having recently conducted a trial on the same subject (2), we feel that some issues require further clarification.Because patient self-testing and self-management are very different, variations in the effectiveness of the 2 interventions deserve special attention. Self-testing enables patients only to monitor the international normalized ratio, whereas self-management empowers patients to take action in achieving better anticoagulation control. Figuratively speaking, self-testing, in contrast to self-management, is like being a passenger watching the speedometer instead of being in the driver's seat. It would therefore be ...

Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes

Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes

Review: Self-testing or self-management of oral anticoagulation reduces thromboembolic events and mortality more than usual care

Source Citation Bloomfield HE, Krause A, Greer N, et al. Meta-analysis: effect of patient self-testing and self-management of long-term anticoagulation on major clinical outcomes. Ann Intern Med. 2011;154:472-82. 21464349