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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

Fanny Bajolle  
1   Centre 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  
2   Université Paris Descartes, Inserm, UMR U765 – Laboratoire d’Hématologie Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
,
Caroline Elie
3   Université Paris Descartes, Service de biostatistique, Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
,
Radhia Cheurfi
1   Centre 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
1   Centre 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
1   Centre 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
1   Centre 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
1   Centre 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
4   Unité thérapeutique et Ecole du cœur CH René DUBOS, Pontoise, France
,
Damien Bonnet
1   Centre 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
› Author Affiliations
Further Information

Publication History

Received: 11 May 2012

Accepted after major revision: 07 August 2012

Publication Date:
29 November 2017 (online)

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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

* FB and DL contributed equally to the work.


 

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