Institute of General Practice, J. W. Goethe University, Frankfurt/Main, EBM Review Center, Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Institute of Biomedicine and Health Sciences (HEALTH), JOANNEUM RESEARCH Forschungsgesellschaft mbh, Graz.
Dtsch Arztebl Int. 2014 Feb 7;111(6):83-91. doi: 10.3238/arztebl.2014.0083.
Properly dosed oral anticoagulation effectively prevents thromboembolic events. It is unclear whether adult patients with an indication for long-term oral anticoagulation can benefit from self-management in terms of patient-oriented endpoints and improved coagulation values.
We selectively searched the Medline database for high-quality systematic reviews based on randomized controlled trials of self-measurement or self-management of oral anticoagulation, compared to standard treatment.
We identified eight review articles based on overlapping sets of ran - domized clinical trials. In all of these systematic reviews, patients who performed self-measurement or self-management had a 40% to 50% lower rate of thromboembolic events; in six of them, the mortality was also significantly lower, by 30% to 50%. Subgroup analysis revealed that these effects were present exclusively in patients who performed self-management, and not in those who only performed self-measurement. None of the review articles revealed any difference in the frequency of severe hemorrhagic events. Quality of life and patient satisfaction were rated in five reviews, which, however, used different instruments, with the result that no clear conclusions could be drawn. All of the review articles documented an improvement in coagulation values, but information on statistical significance was mostly lacking.
Adults with an indication for long-term oral anticoagulation benefit from self-management, as compared to standard treatment with management of dosing by a physician. A limitation of this study is that the multiple review articles on which it is based were largely analyses of the same group of clinical trials.
适当剂量的口服抗凝剂可有效预防血栓栓塞事件。目前尚不清楚，对于有长期口服抗凝治疗指征的成年患者而言，在患者导向的终点和改善凝血值方面，自我管理是否能带来获益。
我们有针对性地在 Medline 数据库中搜索了基于随机对照试验的高质量系统评价，这些试验比较了自我测量或自我管理口服抗凝治疗与标准治疗。
我们基于重叠的随机临床试验集确定了 8 篇综述文章。在所有这些系统评价中，进行自我测量或自我管理的患者发生血栓栓塞事件的风险降低了 40%至 50%；在其中 6 篇文章中，死亡率也显著降低了 30%至 50%。亚组分析显示，这些效果仅存在于进行自我管理的患者中，而不是仅进行自我测量的患者中。没有一篇综述文章显示严重出血事件的发生率有任何差异。有 5 篇综述评价了生活质量和患者满意度，但它们使用了不同的工具，因此无法得出明确的结论。所有的综述文章都记录了凝血值的改善，但关于统计学意义的信息大多缺失。
与由医生管理剂量的标准治疗相比，长期口服抗凝治疗指征的成年人从自我管理中获益。本研究的局限性在于，它所基于的多篇综述文章在很大程度上是对同一组临床试验的分析。
