311 Home INR monitoring of oral anticoagulation therapy in children using a point-of-care INR monitor after an education program

Abstract

The literature demonstrated that children receiving anticoagulation therapy require more frequent monitoring than their adult counterparts due, in part, to the complexity of their underlying medical conditions. Since June 2008, point-of-care International Normalized Ratio (POC INR) monitor are refund by Social Security in France for paediatric patients. The aim of this study is to evaluate the outcomes of home INR monitoring in children through a standardized education and training program. The POC INR monitor is refund for under eighteen patients with a cardiologic or non cardiologic indications. Participating parents had to complete a one-day intensive education and training program. After demonstrating theoretical and practical competences, parents commenced home monitoring. We analysed the proportion of INR within the target range, the incidence of anticoagulant related adverse events and the quality of life of children and parents. We included 48 children (between 2 months and 17 years old). Eighteen patients had a mitral valve replacement and 6 an aortic valve replacement. Fifteen patients had a total cavopulmonary derivation, 7 a dilated cardiomyopathy, 1 coronary aneurysms after Kawasaki disease and 1 an antiphospholipid syndrome. Twenty-eight patients received anticoagulation therapy for the first time and 20 had been treated for a long time and switched from venipuncture to point-of-care monitor. The results of the theoretical test of parents were excellent (average 17.3/20). Only 3 families had practical difficulties at home. 65% of INRs were within the target range. There were no haemorrhagic and thrombosis complications. The quality of life was improved. This education and training program was perfectly safe and improved the quality of life of patients and parents. The use of similar education program may serve to improve the outcomes of home monitoring for anticoagulation therapy in children.