What is the effect of self-monitoring or self-management of OAC therapy on thromboembolic events, major bleeding, and death?
A recent Cochrane review revealed a significant decrease in thromboembolic events (RR, 0.69; participants in 11 studies) and with both self-monitoring (RR, 0.69; participants in 11 studies), although not all patients were AF. There was no overall reduction in the risk of death (RR, 0.83; 95% CI, 0.50-1.37; 7,844 participants in 27 studies); however, self-management did reduce all-cause mortality (RR, 0.52; 95% CI, 0.35-0.77; 5,748 participants in 8 studies). Neither self-monitoring nor self-management reduced the risk of major bleeding compared with standard OAC monitoring (RR, 0.95; 95% CI, 0.80-1.12; 8,018 participants in 20 studies). Rating of the quality of evidence was low to moderate, and the findings should be interpreted accordingly.