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.
Bradbury
M J E
MJ
Department of Haematology, The Birmingham Children's Hospital NHS Trust, Birmingham, UK.
Taylor
G
G
Short
P
P
Williams
M D
MD
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