Self-management of oral anticoagulant therapy: a systematic review and meta-analysis.

BACKGROUND A number of randomized controlled trials have compared self-management of oral anticoagulant therapy with conventional management. However, the results have not appeared consistent and a systematic review and meta-analysis are therefore needed in order to evaluate self-management of oral anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of self-management of oral anticoagulant therapy for patients on long-term oral anticoagulant therapy. METHODS A systematic review and meta-analysis including randomized controlled trials with highly selected patients comparing self-management of oral anticoagulant therapy with conventional treatment. Data were extracted in terms of study characteristics, quality of trials and outcome (death, minor and major complications (thromboembolic and bleeding events), and time within therapeutic INR target range). RESULTS Ten trials with a total of 2724 patients were included. Two of the trials could be classified as high quality trials. Considering all trials, self-management was associated with a reduced risk of death (relative risk (RR)=0.48, 95% confidence interval (CI) 0.29-0.79, p=0.004), major complications (RR=0.58, 95% CI 0.42-0.81, p=0.001) and with increasing time within therapeutic INR target range (weighted mean difference=6.53, 95% CI 2.24-10.82, p=0.003). No clear effect was found regarding minor complications (RR=0.98, 95% CI 0.49-1.99, p=0.96). CONCLUSIONS A majority of the existing trials have various methodological problems. However, self-management of oral anticoagulant therapy appeared at least as good and possible better than conventional management in highly selected patients.