International normalized ratio self-testing and self-management: improving patient outcomes
Matteo Pozzi,1 Julia Mitchell,2 Anna Maria Henaine,3 Najib Hanna,4 Ola Safi,4 Roland Henaine2 1Department of Adult Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France; 2Department of Congenital Cardiac Surgery, “Louis Pradel” Cardiologic Hospita...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2016-10-01
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| Series: | Vascular Health and Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/international-normalized-ratio-self-testing-and-self-management-improv-peer-reviewed-article-VHRM |
| _version_ | 1818353978847526912 |
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| author | Pozzi M Mitchell J Henaine AM Hanna N Safi O Henaine R |
| author_facet | Pozzi M Mitchell J Henaine AM Hanna N Safi O Henaine R |
| author_sort | Pozzi M |
| collection | DOAJ |
| description | Matteo Pozzi,1 Julia Mitchell,2 Anna Maria Henaine,3 Najib Hanna,4 Ola Safi,4 Roland Henaine2 1Department of Adult Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France; 2Department of Congenital Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France; 3Clinical Pharmacology Unit, Lebanese University, Beirut, Lebanon; 4Pediatric Unit, “Hotel Dieu de France” Hospital, Saint Joseph University, Beirut, Lebanon Abstract: 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. Keywords: oral anticoagulation, vitamin K antagonists, international normalized ratio, INR self-management, INR self-testing |
| first_indexed | 2024-12-13T19:18:07Z |
| format | Article |
| id | doaj.art-917ff67e021449a094939f5cc298c831 |
| institution | Directory Open Access Journal |
| issn | 1178-2048 |
| language | English |
| last_indexed | 2024-12-13T19:18:07Z |
| publishDate | 2016-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-917ff67e021449a094939f5cc298c8312022-12-21T23:34:14ZengDove Medical PressVascular Health and Risk Management1178-20482016-10-01Volume 1238739229399International normalized ratio self-testing and self-management: improving patient outcomesPozzi MMitchell JHenaine AMHanna NSafi OHenaine RMatteo Pozzi,1 Julia Mitchell,2 Anna Maria Henaine,3 Najib Hanna,4 Ola Safi,4 Roland Henaine2 1Department of Adult Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France; 2Department of Congenital Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France; 3Clinical Pharmacology Unit, Lebanese University, Beirut, Lebanon; 4Pediatric Unit, “Hotel Dieu de France” Hospital, Saint Joseph University, Beirut, Lebanon Abstract: 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. Keywords: oral anticoagulation, vitamin K antagonists, international normalized ratio, INR self-management, INR self-testinghttps://www.dovepress.com/international-normalized-ratio-self-testing-and-self-management-improv-peer-reviewed-article-VHRMoral anticoagulationvitamin K antagonistsinternational normalized ratioINR self-managementINR self-testing |
| spellingShingle | Pozzi M Mitchell J Henaine AM Hanna N Safi O Henaine R International normalized ratio self-testing and self-management: improving patient outcomes Vascular Health and Risk Management oral anticoagulation vitamin K antagonists international normalized ratio INR self-management INR self-testing |
| title | International normalized ratio self-testing and self-management: improving patient outcomes |
| title_full | International normalized ratio self-testing and self-management: improving patient outcomes |
| title_fullStr | International normalized ratio self-testing and self-management: improving patient outcomes |
| title_full_unstemmed | International normalized ratio self-testing and self-management: improving patient outcomes |
| title_short | International normalized ratio self-testing and self-management: improving patient outcomes |
| title_sort | international normalized ratio self testing and self management improving patient outcomes |
| topic | oral anticoagulation vitamin K antagonists international normalized ratio INR self-management INR self-testing |
| url | https://www.dovepress.com/international-normalized-ratio-self-testing-and-self-management-improv-peer-reviewed-article-VHRM |
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