title: Evaluating safety, effectiveness, and user satisfaction of home international normalized ratio monitoring service: experience from a tertiary pediatric cardiology unit in the United Kingdom.
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.
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA. dbhat@metrohealth.org
authors.forename: Deepti
authors.initials: D
authors.lastname: Bhat
authors.forename: Ajay
authors.initials: A
authors.lastname: Upponi
authors.forename: Aditya
authors.initials: A
authors.lastname: Rakecha
authors.forename: John
authors.initials: J
authors.lastname: Thomson
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003258:Consumer Behavior; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D018575:Home Care Services, Hospital-Based; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D012449:Safety; D017216:Telemedicine; D006113:United Kingdom; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin