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

Thomas Decker Christensen; Torben Bjerregaard Larsen; Vibeke E. Hjortdal

doi:10.1160/TH11-04-0217

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(03): 391-397
DOI: 10.1160/TH11-04-0217

Review Article

Schattauer GmbH

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

Thomas Decker Christensen

¹Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark

,

Torben Bjerregaard Larsen

²Department of Cardiology, Aalborg Hospital & Department of Health Science and Technology, Aalborg University, Denmark

,

Vibeke E. Hjortdal

¹Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark

› Author Affiliations

Abstract

Summary

Children 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.

Keywords

Paediatric - self-testing - self-management - anticoagulation - point of care

Full Text

References

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