Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data.

Background: Uptake of self-testing and self-management of oral anticoagulation [corrected] has remained inconsistent, despite good evidence of their effectiveness. To clarify the value of self-monitoring of oral anticoagulation, we did a meta-analysis of individual patient data addressing several important gaps in the evidence, including an estimate of the effect on time to death, first major haemorrhage, and thromboembolism.

Methods: We searched Ovid versions of Embase (1980-2009) and Medline (1966-2009), limiting searches to randomised trials with a maximally sensitive strategy.

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy.

Background: Patient self-management of long-term oral anticoagulation therapy is an effective strategy in a number of clinical situations, but it is currently not a funded option in the Canadian health care system. We sought to compare the incremental cost and health benefits of self-management with those of physician management from the perspective of the Canadian health care payer over a 5-year period.

Methods: We developed a Bayesian Markov model comparing the costs and quality-adjusted life years (QALYs) accrued to patients receiving oral anticoagulation therapy through self-management or physician management for atrial fibrillation or for a mechanical heart valve.

Clinical impact of point-of-care vs laboratory measurement of anticoagulation.

Patients using anticoagulation point-of-care (POC) monitors are advised to periodically test these systems against laboratory methods to monitor performance. The international normalized ratio (INR), however, can vary between test systems owing to different instrument-reagent combinations. In a randomized study evaluating warfarin self-management, we compared INR measured by patients on a POC monitor (ProTime, International Technidyne Corporation, Edison, NJ) with those obtained at a hospital laboratory within 1 hour Ninety-one paired INR determinations from 55 patients met inclusion criteria.

Glycoprotein IIb/IIIa inhibitors in patients with end-stage renal disease.

Objective: To determine whether glycoprotein IIb/IIIa inhibitors (GPIs) are effective and safe as adjunctive therapy for percutaneous coronary intervention (PCI) in patients with end-stage renal disease (ESRD).

Data Sources: MEDLINE (1966-June 2004), EMBASE (1980-June 2004), and International Pharmaceutical Abstracts (1970-June 2004) were searched, in addition to a manual bibliographic search.

Data Synthesis: Even though GPIs have an established role as adjunctive therapy in PCI, little is known about their use in patients with ESRD.

A randomized trial of patient self-managed versus physician-managed oral anticoagulation.

Background: Self-management (SM) of warfarin by patients is an attractive strategy, particularly if it improves anticoagulation control and can be done safely under minimal physician supervision.

Objective: To compare the effect of SM with physician-management (PM) on the maintenance of therapeutic anticoagulation.

Methods: A randomized, open-label eight-month trial was performed.

Patient self-management of oral anticoagulation: a review.

Self-management of warfarin is an evolving strategy that involves self-testing of the international normalized ratio using a point-of-care device and adjustment of warfarin dosage by the patient using a dosage-adjustment nomogram. There is mounting evidence from clinical trials that self-management of warfarin is feasible and is potentially superior to conventional management by physicians in maintaining anticoagulation control. Some advantages of this strategy are convenience, rapid availability of results with timely adjustment of warfarin dosages, increased patient responsibility for their own therapy and enhanced patient satisfaction.

Switching from abciximab to eptifibatide for percutaneous coronary interventions: a local analysis (SWAP study).

Background: Glycoprotein IIb/IIIa inhibitors (GPI) are recommended as adjunctive therapy with percutaneous coronary interventions (PCI). Before October 2000, abciximab (AB) was the only GPI available at the authors' institution. Eptifibatide (EP) was added to the formulary in October 2000 and became the preferred agent primarily due to lower cost.

Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study.

Objective: To evaluate the efficacy of captopril for management of hypertensive urgencies in autonomic dysreflexia.

Design: A 1-year, prospective, open-label pilot study.

Setting: Rehabilitation hospital.