title: Home management of INR in the public health system: feasibility of self-management of oral anticoagulation and long-term performance of individual POC devices in determining INR.
abstract: The home prothrombin time/international normalized ratio (PT/INR) self-management could be convenient for patients, enhancing treatment compliance and improving the quality of the oral anticoagulation. However, patient self-management (PSM) of oral anticoagulation may not be feasible for up to half of the patients due to cognitive or educational issues. In the present study, we aimed to evaluate the feasibility of a PSM program in a public health medical center that provides care for low-income patients. We also aimed to determine the accuracy of individual point-of-care devices (CoaguChek XS(®)) during long-term of home manipulation. Patients' time-in-therapeutic range (TTR) and perception of quality of life, were evaluated at scheduled study-visits to the center. Additionally, the accuracy of individual CoaguChek XS(®) was evaluated in comparison to the standard automated coagulometer at scheduled study-visits to the center. Twenty-five patients were included in the PSM program. The median TTR of patients was 75 % before inclusion, 72 % at 3 months, 75 % at 6 months and 100 % at 12 months after the beginning of self-management (P = 0.14).The median DASS scores were 64, 63, 61.5 and 71.5 before inclusion and at 3, 6 and 12 months, respectively (P = 0.09). One hundred paired INR values were obtained. Correlation between INR values delivered by individual CoaguChek XS(®) and the automated coagulometer was 94 % and the mean result bias was 0.07 INR units. The coefficient of correlation and the mean bias between methods was stable during 24 months of follow-up. The present study suggests that PSM is feasible for patients treated in the public health system and that the results delivered by CoaguChek XS(®) have long-term reliability.
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.
authors: Sabrina
authors: S
authors: da Silva Saraiva
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil. ferorsi@unicamp.br.|Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-887, Brazil. ferorsi@unicamp.br.
authors: Fernanda Andrade
authors: http://orcid.org/0000-0002-7908-9073
authors: FA
authors: Orsi
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.
authors: Marcos Pereira
authors: MP
authors: Santos
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.
authors: Tania
authors: T
authors: Machado
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.
authors: Silmara
authors: S
authors: Montalvão
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.
authors: Carolina
authors: C
authors: Costa-Lima
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.|Discipline of Hematology and Hemotherapy, Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-887, Brazil.
authors: Erich Vinícius
authors: EV
authors: de Paula
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.
authors: Marina Pereira
authors: MP
authors: Colella
authors: Hematology and Hemotherapy Center, University of Campinas, Rua Carlos Chagas, 480, Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-970, Brazil.|Discipline of Hematology and Hemotherapy, Department of Clinical Medicine, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo, 126. Cidade Universitária "Zeferino Vaz", Campinas, SP, CEP: 13083-887, Brazil.
authors: Joyce
authors: J
authors: Annichino-Bizzacchi
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods; D005240:Feasibility Studies; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D019934:International Normalized Ratio; D019095:Point-of-Care Systems / Q000592:standards*; D011634:Public Health; D011788:Quality of Life; D015203:Reproducibility of Results; D012648:Self Care / Q000592:standards*
chemical_list: D000925:Anticoagulants
keywords: Management; Oral anticoagulation; Point-of-care; Quality control; Time in therapeutic range