Self-monitoring of blood-thinning treatment almost halves risk of developing blood clots compared with conventional care (The Lancet)

The therapeutic range for VKA is narrow and therefore requires regular monitoring and dose adjustment to prevent excessive anticoagulation that can result in major bleeding, or inadequate anticoagulation that can expose patients to the potentially fatal blood clots they are used to prevent.

Self-monitoring can improve the quality of anticoagulation and be more convenient for patients. Yet, the use of self-testing (patients test, but dosage is done by physicians) and self-management (patients test and adjust their own doses) has remained inconsistent both in and between countries, ranging from 20% of patients on anticoagulant therapy in Germany to just 1% of patients in the USA.

To provide more evidence of the benefit of self-monitoring, a team led by Carl Heneghan from the University of Oxford, Oxford, UK, pooled individual patient data from 11 randomised trials comparing self-monitoring of oral anticoagulation with conventional care.

They estimated the effect of self-monitoring on time to death, first major bleeding event, first thromboembolic event, and in important subgroups of patients such as the elderly and those with atrial fibrillation (a common and strong risk factor for stroke) and those with a mechanical heart valve.

Overall, self-monitoring reduced the risk of thromboembolic events by 49% compared with usual care. However, the rate of bleeding complications was similar in both groups and self-monitoring did not have a major effect on mortality.

The authors conclude: "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."

Heneghan C et al (Dec. 1, 2011)