Premium
Supplemental patient education for patients taking oral anticoagulants: systematic review and meta‐analysis
Author(s) -
Wong P. Y. H.,
Schulman S.,
Woodworth S.,
Holbrook A.
Publication year - 2013
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12107
Subject(s) - medicine , meta analysis , rivaroxaban , dabigatran , intensive care medicine , warfarin , atrial fibrillation
Summary Objective Lack of patient knowledge has been associated with poor anticoagulation control, but the effect of patient education on clinical outcomes is unclear. We systematically reviewed the effect of supplemental patient education vs. usual care on hemorrhage, thromboembolic events ( TEE s), time in therapeutic range ( TTR ) and knowledge test scores for all oral anticoagulants. Data sources The data sources were electronic databases, including MEDLINE, EMBASE , CENTRAL , CINAHL and IPA , to February 2012 examining any oral anticoagulant. We reviewed references for additional potentially relevant studies. Methods Only randomized controlled trials ( RCT s) were considered. Data extraction and quality assessment were conducted with GRADE . Pooled relative risks ( RR s) were calculated, and heterogeneity was determined by use of χ 2 and I 2 statistics. Results Seven RCT s ( n = 1209) were included in the systematic review, and five RCT s ( n = 847) in the meta‐analysis. All included studies examined vitamin K antagonists. No significant difference was found for hemorrhage ( RR 0.92, 95% confidence interval [ CI ] 0.04–20.56), TEE ( RR 0.66, 95% CI 0.10–4.39), a composite outcome of hemorrhage or TEE ( RR 0.48, 95% CI 0.23–1.01), or TTR (mean absolute difference of 2.02%, 95% CI − 2.81 to 6.84). Evidence was conflicting on the impact of supplemental education on test scores. All trials had at least one substantial methodologic limitation. Conclusion Current evidence does not support supplemental patient education as a means to improve patient outcomes, but the quality of this evidence is poor. Larger randomized trials are needed with longer follow‐up, recruitment of patients initiating anticoagulation in primary care settings, and clearly defined education interventions.