title: Point-of-care testing INR: an overview.
abstract: Oral anticoagulant therapies with the anti-vitamin K drugs (AVK), warfarin, acenocoumarol and phenprocoumon, are employed in primary and secondary anti-thrombotic prophylaxis in patients with venous thromboembolism, atrial fibrillation and cardiac mechanical valves. However, a monitoring test such as the International Normalized Ratio (INR) is required. The periodic monitoring of this therapy entails discomfort for the patients. Telemedicine and telecare can provide significant aid in the management of this therapy allowing patients to perform the test at home or anywhere else with a portable device, i.e. point-of-care testing (POCT), and to send the result to a thrombosis (TC) via web. Patients can receive dose adjustment sent back by the TC. The effectiveness of this type of management is equal or superior to the traditional AVK monitoring in terms of hemorrhagic and thrombotic events. Analysis of the costs with a horizon of 10 years reveals that both self-testing and self-management are cost-effective. The aim of this overview is to describe the pros and cons of the use of POCT as an alternative in the monitoring of AVK. In particular, description of the POCT, decentralization, quality of the therapy, safety and costs will be examined.
authors.affiliation: Department of Medical Sciences "Mario Aresu", University of Cagliari, Cagliari.
authors.forename: Doris
authors.initials: D
authors.lastname: Barcellona
authors.affiliation: Department of Medical Sciences "Mario Aresu", University of Cagliari, Cagliari.
authors.forename: Lara
authors.initials: L
authors.lastname: Fenu
authors.affiliation: Head of the Internal Medicine and Haemocoagulophaties Unit, University of Cagliari, Cagliari.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marongiu
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology; D003365:Costs and Cost Analysis; D006801:Humans; D019934:International Normalized Ratio / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D000067716:Point-of-Care Testing / Q000191:economics; D012449:Safety; D013997:Time Factors
chemical_list: D000925:Anticoagulants
keywords: International Normalized Ratio (INR); anti-vitamin K antagonists; bleeding; point-of-care testing (POCT); self-management; self-testing; thromboembolism