Related Experiment Videos

EMPoWarMENT: Edmonton pediatric warfarin self-management pilot study in children with primarily cardiac disease

M E Bauman1, K Black, M L Bauman

  • 1Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada. mary.bauman@albertahealthservices.ca

Thrombosis Research
|June 30, 2010
PubMed

Insights

Patient self-management (PSM) of warfarin therapy is safe and effective for children, improving quality of life. This approach empowers families in managing anticoagulant medication, similar to adult studies.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Patient Management

Background:

  • Increasing pediatric use of warfarin for thromboprophylaxis.
  • Home INR testing (PST) allows patient involvement, but requires health team guidance for dosing.
  • Patient self-management (PSM) enables active patient/family participation in warfarin dosing.

Purpose of the Study:

  • Evaluate safety and efficacy of PSM versus PST in children.
  • Assess warfarin dose decision-making in PSM.
  • Examine warfarin-related quality of life (QOL) in pediatric patients.

Main Methods:

  • Randomized controlled trial comparing PST and PSM in warfarinized children with >3 months PST experience.
  • PSM group received education for independent warfarin management.
  • Collected INR data for TTR, assessed decision-making and QOL via inventories and interviews.

Main Results:

  • 28 children completed 12 months of follow-up.
  • Therapeutic Range (TTR) remained high and comparable between groups (83.9% pre/post, 77.7% vs 83.0% for PST/PSM).
  • Appropriate warfarin decision-making was 90%, with no major bleeding or thromboembolic events; families preferred PSM.

Conclusions:

  • Pediatric PSM is a potentially safe and effective warfarin management strategy.
  • Further clinical studies with larger sample sizes are warranted to confirm findings.
  • PSM may improve adherence and QOL for pediatric patients on warfarin.
Abstract

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...