title: EMPoWarMENT: Edmonton pediatric warfarin self-management pilot study in children with primarily cardiac disease.
abstract: Increasing numbers of children require warfarin thromboprophylaxis. Home INR testing by the patient (PST) has revolutionized warfarin management. However, the family/patient must contact the health team for guidance for warfarin dosing. Patient self management(PSM) prepares a patient performing PST to take an active role in warfarin dosing. Adult studies demonstrate that PSM is safe and effective with improved adherence and treatment satisfaction quality of life (QOL).
  
  
  OBJECTIVE
  To estimate the safety and efficacy in children performing PSM or PST, to evaluate warfarin dose decision making in PSM, and warfarin related QOL.
  
  
  METHODS
  Warfarinized children performing PST for >3m were randomized to PST or PSM. The PSM group underwent warfarin management education and assumed independent warfarin management. INRs were collected for a year prior to and for 1 year of study to determine TTR and warfarin decision making. QOL was assessed through inventory completion and interviews.
  
  
  RESULTS
  28 children were randomized and followed for 12 months. TTR was (83.9% pre/ post), and 77.7% pre to 83.0% post for PST and PSM (p=0.312). Appropriate warfarin decision making was 90% with no major bleeding episodes and no thromboembolic events. PSM was preferred by families.
  
  
  CONCLUSIONS
  PSM for children may be a safe and effective management strategy for warfarinized children. Clinical studies with larger sample size are required.
authors.affiliation: Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. mary.bauman@albertahealthservices.ca
authors.forename: M E
authors.initials: ME
authors.lastname: Bauman
authors.forename: K
authors.initials: K
authors.lastname: Black
authors.forename: M L
authors.initials: ML
authors.lastname: Bauman
authors.forename: A A K
authors.initials: AA
authors.lastname: Bruce
authors.forename: S
authors.initials: S
authors.lastname: Kuhle
authors.forename: L
authors.initials: L
authors.lastname: Bajzar
authors.forename: M P
authors.initials: MP
authors.lastname: Massicotte
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D006331:Heart Diseases / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019934:International Normalized Ratio; D010865:Pilot Projects; D011788:Quality of Life; D012646:Self Administration; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin