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. 2016 Jul 5;2016(7):CD003839. doi: 10.1002/14651858.CD003839.pub3

Beyth 2000.

Study characteristics
Methods Multicentre, randomised controlled trial.
Participants 325 hospitalised patients aged 65+ years (mean age 75 years) commencing warfarin therapy of at least 10 days duration. The study was based in several university hospitals (Cleveland, Ohio, USA).
Exclusions included: warfarin therapy within previous 6 months; admission from nursing home; too ill to give informed consent.
Interventions Self‐monitoring vs usual care
The intervention group (n = 163) used home self‐testing using Coumatrak Protime Test System® to self‐monitor prothrombin time. 1‐hour education session, patients phoned results to coach who made recommendations on dosage adjustment.
The conventional management group (n = 162) received medical care including management, dosing and medical information managed by primary care physician as per usual care.
Randomisation was stratified according to baseline risk for major bleeding.
Outcomes Primary outcome: first major bleeding event during the 6‐month intervention period.
Secondary outcomes: death; recurrent venous thromboembolism at 6 months; major bleeding after 6 months; percentage time INR within target range.
Trial identification  
Study duration 6 months
Oral anticoagulant used Warfarin
Notes One‐to‐one training, lasting 30‐60 minutes. Participants instructed to check prothrombin 3 times in the first week after hospital discharge and weekly in the first month, and monthly thereafter depending on the results. 100% up at 6 months.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Randomisation stated to have been done but no method reported.
Allocation concealment (selection bias) Low risk Clearly adequate concealment.
Intention to treat analysis Low risk ITT analysis was performed.
Reporting of losses of follow‐up Unclear risk < 20% losses to follow‐up.
Blinding Low risk Blinded data collectors.