title: International normalized ratio self-testing and self-management: improving patient outcomes.
abstract: Long term oral anti-coagulation with vitamin K antagonists is a risk factor of hemorrhagic or thromebomlic complications. Periodic laboratory testing of international normalized ratio (INR) and a subsequent dose adjustment are therefore mandatory. The use of home testing devices to measure INR has been suggested as a potential way to improve the comfort and compliance of the patients and their families, the frequency of monitoring and, finally, the management and safety of long-term oral anticoagulation. In pediatric patients, increased doses to obtain and maintain the therapeutic target INR, more frequent adjustments and INR testing, multiple medication, inconstant nutritional intake, difficult venepunctures, and the need to go to the laboratory for testing (interruption of school and parents' work attendance) highlight those difficulties. After reviewing the most relevant published studies of self-testing and self-management of INR for adult patients and children on oral anticoagulation, it seems that these are valuable and effective strategies of INR control. Despite an unclear relationship between INR control and clinical effects, these self-strategies provide a better control of the anticoagulant effect, improve patients and their family quality of life, and are an appealing solution in term of cost-effectiveness. Structured education and knowledge evaluation by trained health care professionals is required for children, to be able to adjust their dose treatment safely and accurately. However, further data are necessary in order to best define those patients who might better benefit from this multidisciplinary approach.
authors: Department of Adult Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France.
authors: Matteo
authors: M
authors: Pozzi
authors: Department of Congenital Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France.
authors: Julia
authors: J
authors: Mitchell
authors: Clinical Pharmacology Unit, Lebanese University, Beirut, Lebanon.
authors: Anna Maria
authors: AM
authors: Henaine
authors: Pediatric Unit, "Hotel Dieu de France" Hospital, Saint Joseph University, Beirut, Lebanon.
authors: Najib
authors: N
authors: Hanna
authors: Pediatric Unit, "Hotel Dieu de France" Hospital, Saint Joseph University, Beirut, Lebanon.
authors: Ola
authors: O
authors: Safi
authors: Department of Congenital Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France.
authors: Roland
authors: R
authors: Henaine
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001777:Blood Coagulation / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D016903:Drug Monitoring / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D019934:International Normalized Ratio; D010349:Patient Compliance; D011237:Predictive Value of Tests; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012648:Self Care / Q000191:economics / Q000379:methods*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: INR self-management; INR self-testing; international normalized ratio; oral anticoagulation; vitamin K antagonists