Self-management of long-term oral anticoagulation therapy in reducing adverse events

Abstract

Background: Treatment of vitamin K antagonist, which is an oral anticoagulation therapy, have a narrow therapeutic window, hence, this requires continuous monitoring and regular dose adjustment. Most of the patients using oral anticoagulation therapy, are not in the correct therapeutic target range which could often lead to serious adverse events. With portable coagulometers, patients can self-test their own international normalized ratio self-manage and perform dose adjustment at home. Aim: To assess if the intervention of self-management compared with standard clinical care reduce clinical adverse events of oral anticoagulation therapy including thromboembolism, bleeding and mortality. Research question: In patients on long-term oral anticoagulation therapy, does self-management reduce mortality, thromboembolic and bleeding events compared to standard clinical monitoring? The PICO elements: Population Patients on long-term oral anticoagulation therapy Intervention Self-management Comparison Standard clinical care Outcome Reduction in adverse events: bleeding, thromboembolism and death The search Method: The search was conducted utilizing six databases to identify the appropriate and most relevant articles which were published between 2003 -2018. The articles considered for inclusion had to meet the following criteria 1. English language 2. Free full-text 3. Peer-reviewed journals 4. Studies including oral anticoagulants, mortality, haemorrhage, thrombosis, self-care, self-management, drug monitoring, atrial fibrillation. Outcome of the search and method of appraisal: Through an intensive search, seven articles met the criteria. Two meta-analysis, two meta-analysis and systematic reviews, one systematic review and two prospective cohort studies. Critical appraisal tools including CASP and PRISMA-P were utilized for all included studies. Ethical issues were also, taken into consideration. Implementations and recommendations: To conduct further studies amongst different age groups and utilizing different coagulometers to determine and clarify certain discrepancies in the obtained results. Sharing knowledge and further training to equip health care workers by organizing conferences and seminars. Conclusion: Self-management seemed to reduce adverse events compared to standard care in patients who require long-term oral anticoagulation therapy however, the importance for further research and studies was emphasised.