Report 9 of the Council on Science and Public Health (A-07)

Home Anticoagulant Monitoring

Summary

Objective.  To describe and evaluate the scientific evidence on the safety and efficacy of home monitoring of oral anticoagulation therapy.

Methods.  Literature searches conducted in the PubMed database for English-language articles published between 1998 and 2007 using the search term home anticoagulation yielded a total of 155 references; 63 articles/reviews directly relevant to the safety and effectiveness of home monitoring of anticoagulation therapy were selected for further review.  An additional 22 references were culled from the 63 articles selected for further review.

Results. United States-specific randomized controlled studies on patient self-management of oral anticoagulant therapy are limited. However, the few US data that exist support the more substantial body of evidence from the United Kingdom, Europe, and Australia that patient self-management is safe and effective.  Appropriate selection and training of patients is necessary, and at least two guidances exist on the appropriate use of home monitoring. 

Conclusions. Patients appear to have improved quality of life and to prefer self-monitoring over conventional techniques.  Cost-effectiveness data are limited and must be improved, but existing data suggest that self-management of anticoagulation therapy is minimally cost-effective and potentially cost-saving. At the present time, however, such data are highly country- and health system-specific.

RECOMMENDATIONS

The following statements, recommended by the Council on Science and Public Health, were adopted by the AMA House of Delegates as  policy and directive at the 2007 AMA Annual Meeting:

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