Impact of the use of point of care devices on the morbidity and the mortality of patients with oral anticoagulation
The objective of this study is to evaluate the impact of International Normalized Ratio testing by point of care devices, on morbidity and mortality of patients treated with oral anticoagulants, in comparison with usual testing in laboratory. A systematic review of literature is performed. Data from selected trials are summarized in a global meta-analysis and also in subgroups meta-analysis, according to the fact that the user of POC device is the patient himself, with or without personal treatment adaptation, the general practitioner or a health professional in an anticoagulation clinic. Results of the global meta-analysis show a reduction of major thromboembolism and all causes mortality but not of major hemorrhage. Subgroup analysis shows that most favorable results are obtained when patient himself realizes the test and adapts the treatment. Results are compared with those of other published meta-analysis and the limits of results' validity are discussed.