What does this research mean for the field?

INR self-monitoring, particularly patient self-management and telemedicine-enabled self-testing, significantly improves anticoagulation control and reduces thromboembolic events without increasing major bleeding in patients on long-term vitamin K antagonist therapy. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the impact of INR self-monitoring strategies on thrombotic and hemorrhagic complications in adults using VKAs.

April 5, 2026Open Access

The Impact of Inr Self-Monitoring (Patient Self-Testing and Self-Management) on the Incidence of Thrombotic and Hemorrhagic Complications in Patients Treated With Vitamin K Antagonists: A Literature Review

Key Points

To assess the impact of INR self-monitoring strategies on thrombotic and hemorrhagic complications in adults using VKAs.
Conducted a literature review of studies from 2015 to 2025

Structured PICO

Do INR self-monitoring strategies (PST and PSM) reduce thrombotic and hemorrhagic complications and improve time in therapeutic range in patients treated with Vitamin K antagonists?

Population

Adults treated with Vitamin K antagonists (VKAs) for conditions such as mechanical heart valves, rheumatic mitral stenosis, and atrial fibrillation

Intervention

INR self-monitoring strategies, including Patient Self-Testing (PST) and Patient Self-Management (PSM), with or without telemedicine support

Comparator

Standard care (traditional clinic-based outpatient INR monitoring)

Outcome

Incidence of thromboembolic events, major bleeding complications, and Time in Therapeutic Range (TTR)hard clinical

INR self-monitoring, particularly intensive patient self-management and telemedicine-enabled self-testing, safely improves anticoagulation control and reduces thromboembolic risk in patients on long-term Vitamin K antagonists.

Abstract

Vitamin K antagonists (VKAs) remain essential in the management of patients with mechanical heart valves, rheumatic mitral stenosis, and selected cases of atrial fibrillation. Because therapeutic effectiveness depends on maintaining the international normalized ratio (INR) within a narrow target range, strategies that improve INR stability are critical to reducing the risks of thromboembolic and hemorrhagic complications. Traditional clinic-based monitoring is limited by infrequent testing and delayed dose adjustments, prompting growing interest in patient self-testing (PST) and patient self-management (PSM). This review assessed the impact of PST and PSM on anticoagulation quality and clinical outcomes in adults treated with VKAs. A targeted PubMed search (2015–2025) identified meta-analyses and randomized controlled trial evaluating INR self-monitoring. Three high-quality sources—a Cochrane review, a network meta-analysis, and a meta-analysis focused on telemedicine-supported PST—served as the primary evidence base. Across studies, both PST and PSM significantly increased time in therapeutic range (TTR), typically by 5–10 percentage points compared with standard care. PSM and telemedicine-assisted PST demonstrated the greatest improvements. Enhanced TTR translated into reductions in thromboembolic events, particularly in high-intensity PSM strategies. Importantly, no increase in major bleeding was observed in any self-monitoring model, indicating a favorable safety profile. In conclusion, INR self-monitoring, especially intensive PSM and telemedicine-enabled PST, offers an effective and safe approach to improving anticoagulation control in patients requiring long-term VKA therapy. These strategies address well-recognized limitations of traditional INR monitoring and support more responsive, patient-centered care.

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Cite This Study

Kolano et al. (Mon,) studied this question.

synapsesocial.com/papers/69d1fc28a79560c99a0a1bcd https://doi.org/https://doi.org/10.31435/ijitss.1(49).2026.4690

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