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

Thomas Decker Christensen1, Torben Bjerregaard Larsen, Vibeke E Hjortdal

  • 1Thomas Decker Christensen, Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Skejby, DK - 8200 Aarhus N, Denmark. tdc@ki.au.dk

Thrombosis and Haemostasis
|June 10, 2011
PubMed

Insights

Patient self-testing and self-management of oral anticoagulation therapy (OAT) show promise for children and adolescents. These methods appear as effective as traditional approaches for selected pediatric patients, though further research is needed.

Area of Science:

  • Pediatric Hematology
  • Pharmacology
  • Clinical Trials

Background:

  • Oral anticoagulation therapy (OAT) in children and adolescents poses challenges including INR fluctuations, lifestyle disruption, and venipuncture pain.
  • Optimizing OAT management can improve treatment quality through innovative approaches like patient self-testing (PST) and patient self-management (PSM).

Purpose of the Study:

  • To review the efficacy and safety of patient self-testing (PST) and patient self-management (PSM) for oral anticoagulation therapy (OAT) in pediatric populations.
  • To assess the current evidence base for these novel management strategies in children and adolescents.

Main Methods:

  • A systematic review was conducted, identifying 11 trials involving children and adolescents on OAT.
  • The review analyzed data from 284 patients with a mean follow-up of 22 months, focusing on methodological quality and outcomes.

Main Results:

  • The studies, predominantly non-randomized, reported time within therapeutic INR target range between 63% and 84%.
  • Coagulometers demonstrated sufficient precision and accuracy for clinical INR estimation, with external quality control suggested.
  • PST and PSM were found to be comparable to conventional management in highly selected pediatric patients.

Conclusions:

  • Patient self-testing and self-management are viable treatment options for carefully selected pediatric patients on OAT.
  • Larger, randomized controlled trials focusing on clinical endpoints are necessary to definitively establish the superiority of PST and PSM over conventional OAT management.

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