Home point-of-care international normalised ratio monitoring sustained by a non-selective educational program in children

Fanny Bajolle; Dominique Lasne; Caroline Elie; Radhia Cheurfi; Aurélie Grazioli; Maladon Traore; Patrick Souillard; Younes Boudjemline; Patrick Jourdain; Damien Bonnet

doi:10.1160/TH12-05-306

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 108(04): 710-718
DOI: 10.1160/TH12-05-306

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Home point-of-care international normalised ratio monitoring sustained by a non-selective educational program in children

Authors

Fanny Bajolle

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Dominique Lasne

²Université Paris Descartes, Inserm, UMR U765 – Laboratoire d’Hématologie Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
Caroline Elie

³Université Paris Descartes, Service de biostatistique, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
Radhia Cheurfi

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Aurélie Grazioli

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Maladon Traore

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Patrick Souillard

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Younes Boudjemline

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Patrick Jourdain

⁴Unité thérapeutique et Ecole du cœur CH René DUBOS, Pontoise, France
Damien Bonnet

¹Centre de Référence Malformations Cardiaques Congénitales Complexes – M3C, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France

Abstract

Summary

Adverse events related to vitamin K antagonist (VKA) therapy might be reduced by point-of-care international normalised ratio (POC INR) monitoring supported by an education program (EP). Our aim was to evaluate the efficacy of a non-selective VKA paediatric EP (regardless of the social, economic, educational or linguistic levels) by analysing the time spent in the therapeutic range (TTR), VKA adverse events and compliance to treatment, and INR control prescriptions. The EP was modified from the pediatric EP previously described but improved by a specifically devised child-focused game. One hundred four consecutive children (median age 8 years) receiving VKA were included in a standardised E P. Patients were in self-testing, and dose adjustments were made by a single physician for three tolerance ranges according to the underlying disease: [2.5–4], [1.8–3.2], and [1.5–2.5]. The median follow-up was 481 days [70–1,001]. The overall TTR was 81.4% [36–100]. The TTR were 74%, 85.6% and 89% for the ranges [2.5–4], [1.8–3.2], and [1.5–2.5], respectively. These results were sustainable during the study period. Only one serious VKA adverse event was recorded. The median number of POC INR tests was 2.5 [1.6–5.7] INR per patient and month. Patients/families performed POC INR when requested in 86.9% of the cases. More than 90% of the families found the EP supportive and wished to follow a long-term reinforcement program. In conclusion, this non-selective child-focused EP for VKA therapy, strongly supported by our dedicated game, is useful in maintaining efficacy, safety and compliance to anticoagulation and its monitoring.

Keywords

Congenital heart disease/defects - education - anticoagulation - point-of-care INR monitoring - children & adolescents

Full Text

References

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