title: Self-testing and self-management of oral anticoagulation therapy in children.
abstract: Children and adolescents on oral anticoagulation therapy (OAT) present special challenges in terms of rapid fluctuations in International Normalised Ratio (INR) values, interruption in daily life due to frequent hospital/doctor visits, and difficulties and pain in the performance of venepuncture. Optimised management of OAT improves the quality of treatment, potentially accomplished by new methods such as patient self-testing (PST) and patient self-management (PSM). A review was performed, identifying 11 trials with children and adolescents. All studies had different methodological problems, predominantly by being non-randomised trials. A total of 284 patients were included with a mean follow-up of 22 months, finding a time within therapeutic INR target range between 63% and 84%. The coagulometers used for estimating the INR values were found to have sufficient precision and accuracy for clinical use, but external quality control is probably advisable. It can be concluded that PST and PSM are at least as good treatment options as conventional management in highly selected children. Larger studies, preferably randomised, controlled trials using clinical endpoints, are obviously needed in order to elucidate whether these new regimens of treatment are superior to conventional management of oral anticoagulation therapy.
authors.affiliation: Thomas Decker Christensen, Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Skejby, DK - 8200 Aarhus N, Denmark. tdc@ki.au.dk
authors.forename: Thomas Decker
authors.initials: TD
authors.lastname: Christensen
authors.forename: Torben Bjerregaard
authors.initials: TB
authors.lastname: Larsen
authors.forename: Vibeke E
authors.initials: VE
authors.lastname: Hjortdal
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002986:Clinical Trials as Topic; D018450:Disease Progression; D006801:Humans; D019934:International Normalized Ratio; D010349:Patient Compliance; D011788:Quality of Life; D012646:Self Administration; D012648:Self Care / Q000379:methods / Q000639:trends; D013923:Thromboembolism / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000925:Anticoagulants