Systematic review of studies of self-management of oral anticoagulation

Andrea Siebenhofer; Andrea Berghold; Peter T. Sawicki

doi:10.1160/TH03-09-0598

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2004; 91(02): 225-232
DOI: 10.1160/TH03-09-0598

Review Article

Schattauer GmbH

Systematic review of studies of self-management of oral anticoagulation

Autor*innen

Andrea Siebenhofer

¹Department of Internal Medicine, Division of Diabetes and Metabolism, Karl-Franzens University Hospital, Graz, Austria
Andrea Berghold

²Institute for Medical Informatics, Statistics and Documentation, Karl-Franzens University, Graz, Austria
Peter T. Sawicki

³Department of Internal Medicine, St. Franziskus Hospital and Institute for Evidence based Medicine, Cologne, Germany

Abstract

Summary

This work is aimed at assessing the evidence for the possible improvement of therapeutic control of anticoagulation, reduction of major bleedings, thromboembolism and improvement of treatment-related quality of life in patients with self-managed oral anticoagulation therapy versus oral anticoagulation patients on routine care. Randomised controlled trials (RCTs) were identified using the COCHRANE LIBRARY, MEDLINE and EMBASE from 1966 to 2003. RCTs were selected involving patients with oral anticoagulation, which were designed to compare a self-management group to a routine care group. Abstracts and keywords were screened and, in the case of potential inclusion, evaluated. We identified nine potentially relevant trials. Five were excluded for the following reasons: double publication, the patients involved performed only selftesting, or the results of the trial were only published as an abstract. Ultimately, four randomised controlled studies fulfilled the criteria for inclusion. Anticoagulation control: Statistical analysis was not possible because of the great variety of international normalised ratio measurements per patient between the different studies. Comparing the four studies, there was no difference in oral anticoagulation control between self-management care and management by a specialised anticoagulation clinic. In comparison with routine care by general practitioners, self-management care was found to be better. Major bleeding, arterial and venous thromboembolism: Data were available for all studies; however, the studies were either underpowered or obviously not valid and therefore not suitable for statistical analysis. Treatment-related quality of life: Data were available for two studies, which showed that self-management could clearly improve treatment-related quality of life. Patients’ self-management can improve the quality of oral anticoagulation as an indirect parameter of a reduced risk for thromboembolic and bleeding complications. Self-management oral anticoagulation treatment is safe and improves treatment-related quality of life. Patients’ self-management is safe and can improve the quality of anticoagulation control, however, no valid long term study has yet actually demonstrated reduction of bleeding and thromboembolic events.

Keywords

Oral anticoagulation - self-management - routine care - specialised anticoagulation clinic - general practitioner

Volltext

Referenzen

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