Portable coagulometers: a systematic review of the evidence on self-management of oral anticoagulant treatment

BACKGROUND AND OBJECTIVE: We aimed to systematically review the scientific evidence about the use of portable coagulometers for patient's self-management of oral anticoagulant treatment. MATERIAL AND METHOD: Systematic review of scientific evidence available from MEDLINE'S, DA-RE's, HTA-Database's, NHS-EED's and The Cochrane Library' s bibliographic databases, from their origin to March 2003. Randomized control trials (RCT) and Quasi - Experimental trials were selected provided that they compared patients in self-management with patients under usual care. The quality of scientific evidence was elicited using the Scottish Intercollegiate Guideline Network (SIGN) recommendations, whilst efficacy and security were descriptively summarized. RESULTS: Twelve (7 RCT and 5 quasi-experimental trials) articles were found, and only two of them provided grade A recommendation. Patients under self-management remained the same or more time in the therapeutic range. The incidence of adverse effects in self-management patients was the same or less than usual care. CONCLUSIONS: The quality of the scientific evidence is heterogeneous. For selected patients, self-management is at least as effective and safe as usual care. New oral anticaogulants, which have shown promising results, should be scrutinized for future changes in service provision.