{"id":14336,"date":"2011-12-01T15:08:14","date_gmt":"2011-12-01T20:08:14","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=14336"},"modified":"2011-12-01T15:08:14","modified_gmt":"2011-12-01T20:08:14","slug":"meta-analysis-finds-benefits-for-self-monitoring-in-some-warfarin-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/12\/01\/meta-analysis-finds-benefits-for-self-monitoring-in-some-warfarin-patients\/","title":{"rendered":"Meta-Analysis Finds Benefits for Self-Monitoring in Some Warfarin Patients"},"content":{"rendered":"<p>Despite the advent of newer anticoagulants that don\u2019t require monitoring, millions of people will continue to take warfarin for many years to come. Now\u00a0<a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(11)61294-4\/fulltext\">a new meta-analysis published in the\u00a0<em>Lancet\u00a0<\/em><\/a>suggests that some of these patients may benefit from self-monitoring.<\/p>\n<p>Carl Heneghan and colleagues analyzed data from 11 trials with 6417 patients on oral anticoagulation and 12,800 person-years of follow-up. They found a significant reduction in thromboembolic events among self-monitoring patients, but no reductions in major hemorrhagic events or death. Patients who were younger than age 55 and those with mechanical heart valves had large reductions in thrombotic events with self-monitoring.<\/p>\n<p>Hazard ratios and 95% confidence intervals for the self-monitoring group and subsets were:<\/p>\n<ul>\n<li>Thromboembolic events: HR\u00a00\u00b751, 0\u00b731\u20130\u00b785<\/li>\n<li>Major hemorrhagic events HR 0\u00b788, 0\u00b774\u20131\u00b706<\/li>\n<li>Death: HR 0\u00b782, 0\u00b762\u20131\u00b709<\/li>\n<li>Thrombotic events in patients &lt;55 years: HR 0\u00b733, 0\u00b717\u20130\u00b766<\/li>\n<li>Thrombotic events in patients with mechanical heart valve: HR 0\u00b752, 0\u00b735\u20130\u00b777).<\/li>\n<\/ul>\n<p>The authors calculated that 21 patients under the age of 55 would need to self-monitor for 1 year to prevent one thromboembolic event. For mechanical valve patients, the NNT was 55.<\/p>\n<p>In\u00a0<a href=\"http:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(11)61748-0\/fulltext\">an accompanying comment<\/a>, Paul Alexander Kyrle and Sabine Eichinger write that self-monitoring should \u201cbe offered to\u00a0patients with mechanical heart valves, especially those younger than 55 years. However, we do not see a place for self-monitoring in other areas of this treatment except for individual patients for whom access to routine usual anticoagulation care is restricted.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Despite the advent of newer anticoagulants that don\u2019t require monitoring, millions of people will continue to take warfarin for many years to come. Now\u00a0a new meta-analysis published in the\u00a0Lancet\u00a0suggests that some of these patients may benefit from self-monitoring. Carl Heneghan and colleagues analyzed data from 11 trials with 6417 patients on oral anticoagulation and 12,800 [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495],"tags":[490,1058,368],"class_list":["post-14336","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","tag-inr","tag-self-monitoring","tag-warfarin"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/14336","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=14336"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/14336\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=14336"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=14336"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=14336"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}