ContextPortable devices are now ava

Context
Portable devices are now available to measure international
normalized ratios in patients receiving warfarin.
Contribution
This review of the effects of patient self-monitoring using
portable monitoring devices found that self-monitoring,
with or without self-management of warfarin dosing, resulted
in fewer deaths and thromboembolic events than
usual care, without an increase in serious bleeding events.
Caution
Most trials were of moderate or lower quality and were
conducted internationally, so generalizability of the findings
to the United States is unknown. The findings may
not apply in settings in which anticoagulation clinics provide
state-of-the-art care.
Implication
Self-monitoring of the international normalized ratio, with
or without self-titration of warfarin, seems to be safe and
more effective than usual care.
—The Editors