February 8, 2022Open Access

Warfarin—Is Self-Care the Best Care?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Warfarin anticoagulation (n=5895). Intervention: Warfarin self-testing via e-Health platform (PST/High/e-Health) vs. Usual care. Primary outcome: Time in therapeutic range (TTR) (MD 5.65%, 95% CI 0.04-11.26).

Key Result

High-intensity warfarin self-testing via an e-Health platform modestly improved time in therapeutic range compared with usual care (MD 5.65%).

PICO

Population

5,895 mostly male adults requiring warfarin anticoagulation across 16 RCTs evaluating the effect of warfarin self-care on anticoagulant control and clinical outcomes.

Intervention / Comparator

Warfarin self-testing via e-Health platform (PST/High/e-Health) vs Usual care

Primary Outcome

Time in therapeutic range (TTR) — MD 5.65% (0.04-11.26)

Main Result

Mean Difference: 5.65 (95% CI 0.04–11.26)

Limitations

Limited number of direct comparisons for outcomes in meta-analyses due to the complexity of interventions
Results for comparisons of clinical outcomes require cautious interpretation because of low statistical power
High attrition rates in some self-management studies

Abstract

Comment on: Clinical Outcomes of Different Warfarin Self-Care Strategies: A Systematic Review and Network Meta-AnalysisThromb Haemost 2022; 122(04): 492-505DOI: 10.1055/a-1677-9608

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