title: Home point-of-care international normalised ratio monitoring sustained by a non-selective educational program in children.
abstract: Adverse events related to vitamin K antagonist (VKA) therapy might be reduced by point-of-care international normalised ratio (POC INR) monitoring supported by an education program (EP). Our aim was to evaluate the efficacy of a non-selective VKA paediatric EP (regardless of the social, economic, educational or linguistic levels) by analysing the time spent in the therapeutic range (TTR), VKA adverse events and compliance to treatment, and INR control prescriptions. The EP was modified from the pediatric EP previously described but improved by a specifically devised child-focused game. One hundred four consecutive children (median age 8 years) receiving VKA were included in a standardised EP. Patients were in self-testing, and dose adjustments were made by a single physician for three tolerance ranges according to the underlying disease: [2.5-4], [1.8-3.2], and [1.5-2.5]. The median follow-up was 481 days [70-1,001]. The overall TTR was 81.4% [36-100]. The TTR were 74%, 85.6% and 89% for the ranges [2.5-4], [1.8-3.2], and [1.5-2.5], respectively. These results were sustainable during the study period. Only one serious VKA adverse event was recorded. The median number of POC INR tests was 2.5 [1.6-5.7] INR per patient and month. Patients/families performed POC INR when requested in 86.9% of the cases. More than 90% of the families found the EP supportive and wished to follow a long-term reinforcement program. In conclusion, this non-selective child-focused EP for VKA therapy, strongly supported by our dedicated game, is useful in maintaining efficacy, safety and compliance to anticoagulation and its monitoring.
authors.affiliation: Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Bajolle
authors.forename: Dominique
authors.initials: D
authors.lastname: Lasne
authors.forename: Caroline
authors.initials: C
authors.lastname: Elie
authors.forename: Radhia
authors.initials: R
authors.lastname: Cheurfi
authors.forename: Aurélie
authors.initials: A
authors.lastname: Grazioli
authors.forename: Maladon
authors.initials: M
authors.lastname: Traore
authors.forename: Patrick
authors.initials: P
authors.lastname: Souillard
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.forename: Patrick
authors.initials: P
authors.lastname: Jourdain
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio / Q000379:methods; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D019095:Point-of-Care Systems; D012648:Self Care; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014812:Vitamin K; D014859:Warfarin