Near patient or point-of-care testing devices have made it possible for people on long-term oral anticoagulation to monitor their blood clotting time measured as the international normalized ration (INR) in the home setting. Patients who self-test can either adjust their medication dose according to a pre-determined dose-INR schedule (self-management) or they can call a clinic to be told the appropriate dose adjustment (self-monitoring). Several published studies suggest these methods of monitoring anticoagulation therapy may be equal to or better than standard monitoring by a physician.
In total, we found 18 randomized trials that compared self-monitoring and self-management with standard monitoring. The combined results of these trials showed a halving of thromboembolic events and all-cause mortality with self-monitoring and self-management and no reduction in the number of major bleeds. Self-management had similar reductions in thromboembolic events and mortality to the overall benefit, with no effect on major bleeds. Self-monitoring halved the number of major haemorrhages that occurred but did not significantly reduce the rates of thrombotic events or all-cause mortality.
In conclusion, self-monitoring or self-management can improve the quality of oral anticoagulant therapy, leading to fewer thromboembolic events and lower mortality, without a reduction in the number of major bleeds. Self-monitoring and self-management are not feasible for all patients, which requires the identification and education of suitable patients.