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At the heart of general practice since 1960

Warfarin study hope

By Sarah Gaines

Self-monitoring of warfarin therapy can substantially reduce mortality among suitable patients, a new meta-analysis concludes.

The researchers predicted self-monitoring would become standard practice in the NHS and called for the Government to provide funding for the necessary machines.

But they acknowledged that not everyone could benefit and said better guidelines were needed to identify suitable patients.

The meta-analysis of 14 trials, published in The Lancet, found warfarin self-monitoring reduced all-cause mortality by 39 per cent. It also cut the risk of thromboembolic events by 55 per cent and major haemorrhage by 35 per cent. Combined self-monitoring and self-adjusted therapy reduced deaths by 63 per cent and thromboembolic events by 73 per cent.

Study leader Dr Carl Hen-eghan, clinical research fellow in the department of primary health care at the University of Oxford, said: 'This [paper] will change practice; we can't keep increasing the number of people with chronic disease and keep providing the management.

'To make a sea change we need it to be available on the NHS ­ that will be the big change.'

Dr Heneghan, who is also a GP in Oxford, said: 'There is a training and resource implication. In my practice we have one patient who came to ask if he could self-monitor ­ he had bought his own machine ­ and as a GP I would support that.

'There are people who are highly motivated and are most likely to benefit and people who probably couldn't self-monitor ­ it's the people in the middle. There are problems in identification.'

Professor David Fitzmaurice, professor of primary care research at the University of Birmingham, was more sceptical about the analysis. He said it had focused too heavily on research in Germany, where anticoagulation treatment was substandard, making it easier to demonstrate an effect.

But he added: 'Our SMART study last year did show with adequate training and follow-up, self-monitoring can benefit up to 25 per cent of patients.'

The study reviewed all published and unpublished data from trials on warfarin self-monitoring, involving 1,585 patients who self-monitored and 1,464 controls.

sgaines@cmpinformation.com

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