Point-of-Care INR Measurement in Children Requiring Warfarin: What has been Evaluated and Future Directions

Bauman, Mary E.; Conroy, S; Massicotte, M. Patricia

doi:10.2217/17455111.2.5.651

Cited by 11 publications

(6 citation statements)

References 45 publications

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“…[84][85][86] Several devices are currently approved for use in children. The CoaguChek (Roche Diagnostics, Basil, Switzerland) has been the device most evaluated in children for INR testing either in a healthcare facility (hospital or clinic) or in the home with INR results phoned to an anticoagulation clinic or physician.…”

Section: Poc Inr Monitoringmentioning

confidence: 99%

“…Furthermore, in randomized trials comparing POC with laboratory-based INR monitoring, POC-based monitoring has been shown to improve the quality of anticoagulation control (time in the therapeutic range) and to reduce thromboembolic and hemorrhagic events. 85 POC INR devices measure a thromboplastin-mediated clotting time from a finger-stick capillary whole-blood sample. Although having unique characteristics, POC INR devices have a similar mode of action.…”

Section: Poc Inr Monitoringmentioning

confidence: 99%

See 1 more Smart Citation

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

284

245

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Section: Poc Inr Monitoringmentioning

confidence: 99%

Section: Poc Inr Monitoringmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

284

245

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“…The use of point-of-care devices for routine INR measurements has demonstrated safety, reliability, and effectiveness in infants and children requiring long-term oral anticoagulation therapy. 28 , 29 …”

Section: Resultsmentioning

confidence: 99%

International normalized ratio self-testing and self-management: improving patient outcomes

Pozzi

Mitchell

Hénaine

et al. 2016

VHRM

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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.

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“…The true incidence of children prescribed long-term treatment is difficult to assess precisely, but an increasing number of children are prescribed OAT (3), especially an increased number of children with congenital heart disease (4). Furthermore, these patients have an increased long-term survival, thereby constituting a growing group of patients on OAT (5).…”

Section: Introductionmentioning

confidence: 99%

“…In children, fluctuating INR measurements require frequent blood sampling and adjustment of doses (11). Other problems exist: concomitant medication, practical problems such as difficulties in performing venepuncture, interruption of attendance at school, interruption of parental professional engagements, problems when going abroad, and compliance (especially in puberty) (2,5). Accordingly, PST and PSM may have potential in a paediatric setting, and the aim of this paper was to review different aspects of major importance for PST and PSM in children.…”

Section: Introductionmentioning

confidence: 99%

Self-testing and self-management of oral anticoagulation therapy in children

Christensen¹,

Larsen²,

Hjortdal³

2011

Thromb Haemost

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SummaryChildren and adolescents on oral anticoagulation therapy (OAT) present special challenges in terms of rapid fluctuations in International Normalised Ratio (INR) values, interruption in daily life due to frequent hospital/doctor visits, and difficulties and pain in the performance of venepuncture. Optimised management of OAT improves the quality of treatment, potentially accomplished by new methods such as patient self-testing (PST) and patient self-management (PSM). A review was performed, identifying 11 trials with children and adolescents. All studies had different methodological problems, predominantly by being non-randomised trials. A total of 284 patients were included with a mean follow-up of 22 months, finding a time within therapeutic INR target range between 63% and 84%. The coagulometers used for esti- mating the INR values were found to have sufficient precision and accuracy for clinical use, but external quality control is probably advisable. It can be concluded that PST and PSM are at least as good treatment options as conventional management in highly selected children. Larger studies, preferably randomised, controlled trials using clinical endpoints, are obviously needed in order to elucidate whether these new regimens of treatment are superior to conventional management of oral anticoagulation therapy.

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Point-of-Care INR Measurement in Children Requiring Warfarin: What has been Evaluated and Future Directions

Cited by 11 publications

References 45 publications

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

International normalized ratio self-testing and self-management: improving patient outcomes

Self-testing and self-management of oral anticoagulation therapy in children

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