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Cochrane Database of Systematic Reviews

Self-monitoring and self-management of oral anticoagulation

Overview of attention for article published in Cochrane database of systematic reviews, July 2016
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (97th percentile)
  • High Attention Score compared to outputs of the same age and source (93rd percentile)

Mentioned by

news
5 news outlets
blogs
2 blogs
twitter
91 tweeters
facebook
3 Facebook pages
wikipedia
1 Wikipedia page

Citations

dimensions_citation
71 Dimensions

Readers on

mendeley
200 Mendeley
citeulike
1 CiteULike
Title
Self-monitoring and self-management of oral anticoagulation
Published in
Cochrane database of systematic reviews, July 2016
DOI 10.1002/14651858.cd003839.pub3
Pubmed ID
Authors

Carl J Heneghan, Josep M Garcia-Alamino, Elizabeth A Spencer, Alison M Ward, Rafael Perera, Clare Bankhead, Pablo Alonso Coello, David Fitzmaurice, Kamal R Mahtani, Igho J Onakpoya

Abstract

The introduction of point-of-care devices for the management of patients on oral anticoagulation allows self-testing by the patient at home. Patients who self-test can either adjust their medication according to a pre-determined dose-INR (international normalized ratio) schedule (self-management), or they can call a clinic to be told the appropriate dose adjustment (self-monitoring). Increasing evidence suggests self-testing of oral anticoagulant therapy is equal to or better than standard monitoring. This is an updated version of the original review published in 2010. To evaluate the effects on thrombotic events, major haemorrhages, and all-cause mortality of self-monitoring or self-management of oral anticoagulant therapy compared to standard monitoring. For this review update, we re-ran the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 6, the Cochrane Library, MEDLINE (Ovid, 1946 to June week 4 2015), Embase (Ovid, 1980 to 2015 week 27) on 1 July 2015. We checked bibliographies and contacted manufacturers and authors of relevant studies. We did not apply any language restrictions . Outcomes analysed were thromboembolic events, mortality, major haemorrhage, minor haemorrhage, tests in therapeutic range, frequency of testing, and feasibility of self-monitoring and self-management. Review authors independently extracted data and we used a fixed-effect model with the Mantzel-Haenzel method to calculate the pooled risk ratio (RR) and Peto's method to verify the results for uncommon outcomes. We examined heterogeneity amongst studies with the Chi(2) and I(2) statistics and used GRADE methodology to assess the quality of evidence. We identified 28 randomised trials including 8950 participants (newly incorporated in this update: 10 trials including 4227 participants). The overall quality of the evidence was generally low to moderate. Pooled estimates showed a reduction in thromboembolic events (RR 0.58, 95% CI 0.45 to 0.75; participants = 7594; studies = 18; moderate quality of evidence). Both, trials of self-management or self-monitoring showed reductions in thromboembolic events (RR 0.47, 95% CI 0.31 to 0.70; participants = 3497; studies = 11) and (RR 0.69, 95% CI 0.49 to 0.97; participants = 4097; studies = 7), respectively; the quality of evidence for both interventions was moderate. No reduction in all-cause mortality was found (RR 0.85, 95% CI 0.71 to 1.01; participants = 6358; studies = 11; moderate quality of evidence). While self-management caused a reduction in all-cause mortality (RR 0.55, 95% CI 0.36 to 0.84; participants = 3058; studies = 8); self-monitoring did not (RR 0.94, 95% CI 0.78 to 1.15; participants = 3300; studies = 3); the quality of evidence for both interventions was moderate. In 20 trials (8018 participants) self-monitoring or self-management did not reduce major haemorrhage (RR 0.95, 95% CI, 0.80 to 1.12; moderate quality of evidence). There was no significant difference found for minor haemorrhage (RR 0.97, 95% CI 0.67 to 1.41; participants = 5365; studies = 13). The quality of evidence was graded as low because of serious risk of bias and substantial heterogeneity (I(2) = 82%). Participants who self-monitor or self-manage can improve the quality of their oral anticoagulation therapy. Thromboembolic events were reduced, for both those self-monitoring or self-managing oral anticoagulation therapy. A reduction in all-cause mortality was observed in trials of self-management but not in self-monitoring, with no effects on major haemorrhage.

Twitter Demographics

The data shown below were collected from the profiles of 91 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 200 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Unknown 199 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 33 17%
Student > Bachelor 28 14%
Researcher 26 13%
Student > Ph. D. Student 24 12%
Student > Postgraduate 15 8%
Other 33 17%
Unknown 41 21%
Readers by discipline Count As %
Medicine and Dentistry 65 33%
Nursing and Health Professions 33 17%
Pharmacology, Toxicology and Pharmaceutical Science 13 7%
Psychology 12 6%
Social Sciences 7 4%
Other 22 11%
Unknown 48 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 105. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 June 2020.
All research outputs
#222,577
of 16,955,011 outputs
Outputs from Cochrane database of systematic reviews
#466
of 11,598 outputs
Outputs of similar age
#6,074
of 265,434 outputs
Outputs of similar age from Cochrane database of systematic reviews
#10
of 140 outputs
Altmetric has tracked 16,955,011 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,598 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 24.5. This one has done particularly well, scoring higher than 95% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 265,434 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 97% of its contemporaries.
We're also able to compare this research output to 140 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 93% of its contemporaries.