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

被引:56
作者
Christensen, Thomas D. [1 ]
Johnsen, Soren P.
Hjortdal, Vibeke E.
Hasenkam, J. Michael
机构
[1] Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Skejby Sygehus, DK-8200 Aarhus N, Denmark
[2] Aarhus Univ Hosp, Inst Clin Med, Skejby Sygehus, DK-8200 Aarhus N, Denmark
[3] Aarhus Univ Hosp, Dept Clin Epidemiol, DK-8000 Aarhus C, Denmark
[4] Aarhus Univ Hosp, Inst Clin Med, DK-8000 Aarhus C, Denmark
关键词
coumarin; anticoagulant; blood coagulation; international normalized ratio;
D O I
10.1016/j.ijcard.2006.06.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 selfmanagement 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, selfmanagement 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% Cl 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% Cl 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. (C) 2006 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:54 / 61
页数:8
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