Oral Anticoagulation Therapy in Children: Successfully Controlled by Self-Management

Abstract Background Between one and two percent of the population of the developed countries are currently treated with oral anticoagulation therapy. The transition of all or part of the responsibility for therapy management to the patient is an appropriate strategy to respond increasing demand for oral anticoagulation therapy. The main objective of this original study was to investigate the impact of using mobile applications on health outcomes in patient self-management of oral anticoagulation therapy. Methods The papers reviewed in this study had two key characteristics: firstly, they were written in English, and secondly, they used mobile application in oral anticoagulation therapy. An Android mobile application called XrinA was developed to provide warfarin patient self-management. The study was conducted following a Before-After study design. In the Before and After periods, patients were treated as usual and by using the developed application, respectively. Results In the Before period, the mean percentage of International Normalized Ratios (INRs) within the therapeutic range and Time in Therapeutic Range (TTR) of patients was 31.63% and 34.4%, respectively. In the After period, the mean percentage of INRs within the therapeutic range and TTR of patients was 41.41% and 49.97%, respectively. In the After period, the mean INRs within the therapeutic range and the mean TTR increased by 9.78% and 15.57%, respectively. Conclusions Overall, the use of mHealth applications improved outcomes in patient self-management of oral anticoagulation therapy in terms of the percentage of INRs within the therapeutic range and TTR.

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Precision and accuracy of point-of-care testing coagulometers used for self-testing and self-management of oral anticoagulation therapy

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2011.04568.x ◽

2012 ◽

Vol 10 (2) ◽

pp. 251-260 ◽

Cited By ~ 67

Author(s):

T. D. CHRISTENSEN ◽

T. B. LARSEN

Keyword(s):

Oral Anticoagulation ◽

Point Of Care ◽

Anticoagulation Therapy ◽

Self Management ◽

Point Of Care Testing ◽

Oral Anticoagulation Therapy ◽

Self Testing ◽

Precision And Accuracy

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Self-management of oral anticoagulation therapy improves long-term survival in patients with mechanical heart valve replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967512 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

H Körtke ◽

A Zittermann ◽

G Tenderich ◽

N Mirow ◽

O Wagner ◽

...

Keyword(s):

Valve Replacement ◽

Heart Valve ◽

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Mechanical Heart Valve ◽

Heart Valve Replacement ◽

Self Management ◽

Term Survival ◽

Oral Anticoagulation Therapy

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Oral Anticoagulation Therapy: The Evolving Role of Patient Self-Testing and Self-Management and the Need for Optimized Training Programs

Point of Care The Journal of Near-Patient Testing & Technology ◽

10.1097/01.poc.0000131938.53707.68 ◽

2004 ◽

Vol 3 (2) ◽

pp. 83

Author(s):

J Ansell ◽

H Völler ◽

U Taborski ◽

I Hartwig ◽

C Dovifat ◽

...

Keyword(s):

Oral Anticoagulation ◽

Training Programs ◽

Anticoagulation Therapy ◽

Self Management ◽

Oral Anticoagulation Therapy ◽

Self Testing

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PSY19 A Cost-Consequence Analysis of Patient Self-Management Versus Physician-Managed Monitoring of Long-Term Oral Anticoagulation Therapy in Canada

Value in Health ◽

10.1016/j.jval.2012.08.1742 ◽

2012 ◽

Vol 15 (7) ◽

pp. A511

Author(s):

S. Lepage ◽

C. Beauchemin ◽

S. de Denus ◽

L. Verret ◽

A. Nguyen ◽

...

Keyword(s):

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Self Management ◽

Oral Anticoagulation Therapy ◽

Consequence Analysis ◽

Cost Consequence

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

Thrombosis and Haemostasis ◽

10.1160/th11-04-0217 ◽

2011 ◽

Vol 106 (09) ◽

pp. 391-397 ◽

Cited By ~ 16

Author(s):

Torben Larsen ◽

Vibeke Hjortdal ◽

Thomas Christensen

Keyword(s):

Children And Adolescents ◽

Oral Anticoagulation ◽

Treatment Options ◽

Anticoagulation Therapy ◽

Self Management ◽

Target Range ◽

Oral Anticoagulation Therapy ◽

Clinical Endpoints ◽

Conventional Management ◽

Self Testing

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 estimating 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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