A meta-analysis published Online First in The Lancet shows that patients who self-monitor their blood-thinning (oralanticoagulation) therapy with vitamin K antagonists (VKA), such as warfarin , almost halve their risk of developing thromboembolic events like stroke , deep vein thrombosis and heart attack compared with those who receive traditional care. About 1 million people in the UK are eligible for oralanticoagulation therapy, and in Europe over 4 million patients aretaking long-term oral anticoagulation for conditions, such ascardiac arrhythmias , artificial heart valves, or with a previous history of bloodclots. As the population is ageing, the demand for oralanticoagulants is predicted to increase dramatically. Each patient responds differently to the same VKA dose. Because thetherapeutic range for VKA is limited, it is necessary to regularlymonitor the patient's blood and, if necessary, adjust the dose toprevent excessive anticoagulation that can lead to major bleeding,or inadequate anticoagulation that can result in patientsdeveloping potentially fatal blood clots that these drugs aresupposed to prevent. It is more convenient for patients to self-monitor as it canimprove the quality of anticoagulation, yet self-testing in whichpatients test themselves with dosage adjustment carried out by adoctor, as well as self-management, when they test themselves andalso adjust their own dosage, remains inconsistent both in andbetween countries, ranging from just 1% of patients in the USA to20% of patients on anticoagulant therapy in Germany. Study leader Carl Heneghan, from the University of Oxford, UK,wanted to provide more evidence on the benefits of self-monitoring.They combined individual patient data from 11 randomized trials,which compared self-monitoring of oral anticoagulation withconventional care. Heneghan and his team estimated the effect of self-monitoring onfirst major bleeding event, first thromboembolic event and time todeath in important patient subgroups, such as the elderly and thosewith atrial fibrillation , a common and significant risk factor for stroke, and those with amechanical heart valve. They discovered that overall, self-monitoring decreased the risk ofthromboembolic events by 49% compared with traditional care butdiscovered that the rate of bleeding complications was comparablein both groups. They also established that self-monitoring had nomajor effect on mortality. They noticed that the benefits of self-monitoring were considerablein those below the age of 55 years, who had a lower than 60% chanceof having a thromboembolic event, and in patients with a mechanicalheart valve, whose risk was halved. Significantly, they noted that self-monitoring decreased mortalityand did not raise complications in old patients, who are at highrisk of major bleeding, which indicates that age should not be usedas a factor to determine whether a person if eligibility toself-manage. In a concluding statement the authors say: "Self-monitoring and self-management of oral coagulation is a safeoption for suitable patients of all ages. Patients should also beoffered the option to self-manage their disease with suitablehealth-care support as back-up." Paul Alexander Kyrle and Sabine Eichinger from the MedicalUniversity of Vienna in Vienna, Austria, state in a linked comment: "Self-management (rather than self-testing) of treatment withvitamin K antagonists should be offered to patients with mechanicalheart valves, especially to those younger than 55 years. However,we do not see a place for self-monitoring in other areas of thistreatment except for individual patients for whom access to routineusual anticoagulation care is restricted." Written by Petra Rattue. We are high quality suppliers, our products such as China Retractable ID Badge Reels , China Conference Name Badge Holders for oversee buyer. To know more, please visits Conference Name Badge Holders.
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