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

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.