Clinical Outcomes of Different Warfarin Self-Care Strategies: A Systematic Review and Network Meta-Analysis
| Autor: | Treeluck Thammathuros, Kansak Boonpattharatthiti, Piyameth Dilokthornsakul, Beth Devine, Itsarawan Sakunrag, Teerapon Dhippayom |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry Network Meta-Analysis fungi Significant difference Warfarin Hematology Random effects model Confidence interval Self Care Systematic review Thromboembolism Relative risk Meta-analysis Internal medicine Self care Humans Medicine International Normalized Ratio business medicine.drug |
| Zdroj: | Thrombosis and Haemostasis. 122:492-505 |
| ISSN: | 2567-689X 0340-6245 |
| DOI: | 10.1055/a-1677-9608 |
| Popis: | Aim To compare the effects of different strategies for warfarin self-care. Methods PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and OpenGrey were searched from inception to August 2021. Randomized controlled trials (RCTs) of warfarin self-care, either patient self-testing (PST) or patient self-management (PSM), were included. Self-care approaches were classified based on the TIP framework (theme, intensity, provider): (1) PST ≥1/week via e-Health (PST/High/e-Health); (2) PST ≥1/week by health care practitioner (PST/High/HCP); (3) PST Results Sixteen RCTs involving 5,895 participants were included. When compared with usual care, time in therapeutic range was higher in PSM/High/Pt and PST/High/e-Health with MD [95% CI] of 7.67% [0.26–15.08] and 5.65% [0.04–11.26], respectively. The certainty of evidence was rated as moderate for these findings. The risk of thromboembolic events was lower in the PSM/Flex/Pt group when compared with PST/High/e-Health (RR: 0.39 [0.20–0.77]) and usual care (RR: 0.38 [0.17–0.88]) with low and very low level of evidence, respectively. There was no significant difference in the proportion of international normalized ratio (INR) values in range, major bleeding, and all-cause mortality among different self-care features. Conclusion Patient self-care (either PST or PSM) by measuring INR values at least once weekly is more effective in controlling the INR level. |
| Databáze: | OpenAIRE |
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