Abstract
Home international normalized ratio (INR) monitors are being increasingly used for monitoring the adequacy of anticoagulation in children on long-term warfarin. Their safety and effectiveness in the home setting has not been fully established. The purpose of this study was to explore the safety and effectiveness of home INR monitoring service in managing anticoagulation in children with congenital heart disease. At the Pediatric Cardiology Regional Referral Center, we studied records of 41 children on warfarin and assessed the control of anticoagulation and frequency of adverse reactions over a 1-year period. User satisfaction was assessed by means of telephone interviews. The study found that the therapeutic INR range was maintained for over 57% of the total study period. There were no reported instances of major or minor hemorrhages. On six occasions, subtherapeutic INR levels necessitated hospitalization for heparinization. Mitral valve replacement was significantly associated with poor control (p < 0.05). User satisfaction was high for all aspects of the service evaluated. The hospital-assisted home INR monitoring service is a safe and effective means of managing anticoagulation in children. In addition, it ensures good compliance and a high level of user satisfaction.
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References
Bereznicki LR, Jackson SL, Peterson GM, Jeffrey EC, Marsden KA, Jupe DM (2007) Accuracy and clinical utility of the CoaguChek XS portable international normalised ratio monitor in a pilot study of warfarin home-monitoring. J Clin Pathol 60(3):311–314
Bradbury MJ, Taylor G, Short P, Williams MD (2008) A comparative study of anticoagulant control in patients on long-term warfarin using home and hospital monitoring of the international normalised ratio. Arch Dis Child 93(4):303–306
Hill J, Perreault S, Dorval M (2007) Validity of CoaguChek S for home monitoring of anticoagulant therapy in pediatrics. Can J Cardiol 23(1):47–50
Lizotte A, Quessy I, Vanier MC, Martineau J, Caron S, Darveau M, Dubé A, Gilbert E, Blais N, Lalonde L (2002) Reliability, validity and ease of use of a portable point-of-care coagulation device in a pharmacist-managed anticoagulation clinic. J Thromb Thrombol 14(3):247–254
Mähönen S, Riikonen P, Väätäinen RL, Tikanoja T (2004) Oral anticoagulant treatment in children based on monitoring at home. Acta Paediatr 93(5):687–691
Marzinotto V, Monagle P, Chan A, Adams M, Massicotte P, Leaker M, Andrew M (2000) Capillary whole blood monitoring of oral anticoagulants in children in outpatient clinics and the home setting. Pediatr Cardiol 21(4):347–352
Newall F, Monagle P, Johnston L (2006) Home INR monitoring of oral anticoagulant therapy in children using the CoaguChek S point-of-care monitor and a robust education program. Thromb Res 118(5):587–593
Acknowledgment
The authors thank Dr Mike Richards, Pediatric Hematologist, at St James University Hospital, Leeds, UK.
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Bhat, D., Upponi, A., Rakecha, A. et al. Evaluating Safety, Effectiveness, and User Satisfaction of Home International Normalized Ratio Monitoring Service: Experience from a Tertiary Pediatric Cardiology Unit in the United Kingdom. Pediatr Cardiol 31, 18–21 (2010). https://doi.org/10.1007/s00246-009-9535-x
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DOI: https://doi.org/10.1007/s00246-009-9535-x