October 30, 2012British Journal of General Practice15 citationsOpen Access

Point-of-care INR coagulometers for self-management of oral anticoagulation: primary care diagnostic technology update

Q: What is the clinical evidence from this study?

Study design: Review. Population: Long-term oral anticoagulation therapy. Intervention: Self-management and self-monitoring of INR using point-of-care coagulometers vs. Standard clinic-based care. Primary outcome: Thromboembolic events (HR 0.51, 95% CI 0.31 to 0.85).

APAnnette Plüddemann MTMatthew Thompson JWJane Wolstenholme

Key Result

Self-monitoring of INR significantly reduces the rate of thromboembolic events (HR 0.51) compared to standard care, but does not significantly reduce the risk of major haemorrhage or death.

Structured PICO

Does self-management using a home monitoring device for INR improve outcomes and accuracy in patients who require long-term anticoagulation treatment compared to standard practice?

Population

Patients requiring long-term oral anticoagulation therapy for conditions such as atrial fibrillation, venous thromboembolism, or prosthetic heart valves.

Intervention

Self-management (self-testing and self-adjusting) or self-monitoring (self-testing and adjustment by clinician) of oral anticoagulation using point-of-care INR coagulometers (e.g., CoaguChek XS, INRatio, ProTime).

Comparator

Standard practice / conventional clinic-based anticoagulation care.

Outcome

Thromboembolic events, major haemorrhage, all-cause mortality, and INR accuracy.hard clinical

Point-of-care INR self-management is as accurate as laboratory testing and significantly reduces thromboembolic events and mortality compared to standard clinic-based care.

Main Result

Hazard Ratio: 0.51 (95% CI 0.31–0.85)

Limitations

Translation of evidence into primary care settings is limited.
Patient self-management may be more expensive than available routine care in some economic models.
Patient level data was not available for some of the cited cost-effectiveness reviews.
Translation of evidence into primary care settings is limited

Abstract

In patients who require long-term anticoagulation treatment, how accurate and effective is self-management using a home monitoring device for INR, compared to standard practice?

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Cite This Study

Plüddemann et al. (2012) conducted a review in Long-term oral anticoagulation therapy. Self-management and self-monitoring of INR using point-of-care coagulometers vs. Standard clinic-based care was evaluated on Thromboembolic events (HR 0.51, 95% CI 0.31 to 0.85). Self-monitoring of INR significantly reduces the rate of thromboembolic events (HR 0.51) compared to standard care, but does not significantly reduce the risk of major haemorrhage or death.

synapsesocial.com/papers/6a82d7c20715daaa1f23c12f https://doi.org/10.3399/bjgp12x658476