title: Safety and Efficacy Outcomes of Home and Hospital Warfarin Management Within a Pediatric Anticoagulation Clinic.
abstract: The complexity of managing children with chronic disease has led to an increase in the use of long-term warfarin therapy. Time in therapeutic range (TTR) is the preferred method for determining efficacy and stability of warfarin management. This study aimed to determine the TTR achievement and incidence of adverse events among pediatric warfarin patients managed by an anticoagulation clinic over 12 months and to compare TTR achievement between patients self-testing (PST) at home and those monitored using routine methods. International normalized ratio (INR) results reported for 2012 for children currently having their warfarin therapy managed by a dedicated pediatric anticoagulation clinic were analyzed. Warfarin-related adverse events were recorded. A total of 164 patients were included. In total, 93 children performed PST and 71 children tested their INR at a hospital or pathology service. TTR achievement for the cohort was 67.1% (95% confidence interval, 64.4-69.7). A total of 69.2% of INR tests conducted at home were within the TTR compared with 64.3% of INR tests conducted at a hospital or pathology service (P=0.07). One major bleeding event occurred and there was 1 thrombotic episode. PST demonstrated noninferior warfarin stability compared with routine methods. Routine outcome evaluation of pediatric anticoagulation management within single institutions is necessary to confirm the success of such programs.
authors.affiliation: Departments of *Nursing §Paediatrics, The University of Melbourne †Haematology Research, Murdoch Childrens Research Institute Departments of ‡Clinical Haematology ∥Nursing Research, The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jones
authors.forename: Siobhan
authors.initials: S
authors.lastname: McLoughlin
authors.forename: Dana
authors.initials: D
authors.lastname: Piovesan
authors.forename: Helen
authors.initials: H
authors.lastname: Savoia
authors.forename: Paul
authors.initials: P
authors.lastname: Monagle
authors.forename: Fiona
authors.initials: F
authors.lastname: Newall
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019934:International Normalized Ratio; D008297:Male; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital; D012648:Self Care / Q000379:methods*; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin