In an attempt to find alternative strategies for anticoagulation treatment several randomized control trials have been undertaken in the last two decades examining the idea of "Patient Self-Management" (PSM) of anticoagulation. In a scheme similar to diabetics monitoring their blood glucose values and altering insulin dosages, patients in these trials have been taught to self-test their INR values using home electronic devices and then adjust their warfarin doses accordingly. Data has been published showing improved control in therapeutic range and decreased complication rates of thromboembolic events and major hemorrhages. There was no significant decrease in mortality in the above studies, although most were not powered to detect this as sample sizes were small (49-737 participants). In 2006 a systematic review and meta-analysis of 14 randomized control trials (RCT's) was published involving 3049 participants comparing "Patient Self-Monitoring" (ie. no adjustment of dose) and/or PSM to standard management Data from seven PSM studies was included which demonstrated a significant decrease in thromboembolic events, a non-significant decrease in major hemorrhagic events, and a significant decrease in mortality. Furthermore, it was shown that patients were more satisfied with PSM strategies. These data are reflected in the American College of Chest Physicians guideline entitled Pharmacology and Management of Vitamin K Antagonists, "In patients who are suitably selected and trained, PST [patient self-testing] or PSM is an effective alternative treatment model. We suggest that such therapeutic management be implemented where suitable".