Supplemental patient education for patients taking oral anticoagulants: systematic review and meta-analysis.
J Thromb Haemost. 2012 Dec 19;
Authors: Wong PY, Schulman S, Woodworth S, Holbrook A
Abstract
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), time in therapeutic range (TTR), and knowledge test scores for all oral anticoagulants. DATA SOURCES: 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 (RCTs) were considered. Data extraction and quality assessment were conducted using GRADE. Pooled relative risks (RR) were calculated, and heterogeneity was determined using ?(2) and I(2) statistics. RESULTS: Seven RCTs (n=1209) were included in the systematic review, and 5 RCTs (n=847) in the meta-analysis. All included studies examined vitamin K antagonists. No significant difference was found for hemorrhage (RR 0.92, 95% 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 2.02%, 95% CI: -2.81, 6.84). Evidence was conflicting on the impact of supplemental education on test scores. All trials had at least one substantial methodological 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. © 2012 International Society on Thrombosis and Haemostasis.
PMID: 23279062 [PubMed - as supplied by publisher]