A comparative study of anticoagulant control in patients on long-term warfarin using home and hospital monitoring of the international normalised ratio.
BACKGROUND
Capillary whole-blood point-of-care prothrombin-INR (PT-INR) testing at home is an alternative to hospital-based monitoring for patients on lifelong warfarin.


OBJECTIVE
To retrospectively assess the safety and efficacy of home point-of-care testing for children on long-term warfarin.


METHODS
All patients who had been on point-of-care home monitoring for at least 6 months were included in the study. Their warfarin control was assessed while on home monitoring and compared to that achieved in a similar period before changing from hospital monitoring.


RESULTS
Thirty-seven patients were studied for a mean of 1.0 year on clinic monitoring and 1.07 years on home monitoring. The clinic monitoring tests were within a therapeutic range for a median 70.0 (inter-quartile range 34.5) and the home monitoring were within range for median 75.0 (inter-quartile range 44.5). There were no major haemorrhagic or thrombotic complications in either group during the study period. Only 2.3% of all tests had an INR greater than 6.0 with no statistical differences seen between the clinic and home monitoring groups.


CONCLUSIONS
Home point-of-care testing in children on lifelong warfarin is safe, effective and offers a number of advantages to the child and family. Ongoing training and support for the families is essential for this service.
Department of Haematology, The Birmingham Children's Hospital NHS Trust, Birmingham, UK.
M J E
MJ
Bradbury
G
G
Taylor
P
P
Short
M D
MD
Williams
D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D004739:England; D006266:Health Education / Q000379:methods; D006302:Health Services Research / Q000379:methods; D006701:Home Nursing / Q000193:education / Q000592:standards*; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D010290:Parents / Q000193:education; D010353:Patient Education as Topic / Q000379:methods; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D014859:Warfarin