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EMPoWARed: Edmonton pediatric warfarin self-management study.
M E Bauman1, M P Massicotte1, S Kuhle2
1Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
Thrombosis Research
|September 13, 2015
Summary
Patient self-management (PSM) of warfarin therapy in children is safe and effective, improving health-related quality of life. Family units demonstrated sustained knowledge and competency in warfarin management over time.
Area of Science:
- Pediatric anticoagulation management
- Patient self-management (PSM) research
- Health-related quality of life (HRQOL) studies
Background:
- Patient self-management (PSM) offers a safer, more cost-effective alternative to conventional treatment for adults.
- Warfarin, a narrow therapeutic index drug, requires long-term management with individualized patient responses.
- Children and their families can be empowered to manage pediatric warfarin therapy, potentially increasing health-related quality of life.
Purpose of the Study:
- To evaluate the safety and efficacy of pediatric patient self-management (PSM) of warfarin over time.
- To assess the impact of PSM on health-related quality of life (HRQOL).
- To identify variables influencing successful patient-family unit (PFU) adherence and competency in PSM.
Main Methods:
- A cohort study enrolled pediatric patient-family units (PFUs) with at least 3 months of warfarin self-testing experience.
- PFUs received comprehensive education and apprenticeship in warfarin testing and management.
- Data collected included socio-demographic, clinical, and laboratory parameters, comparing the first 6 months (phase 1) with the last 6 months (phase 2) of PSM.
Main Results:
- Forty-two PFUs demonstrated sustained warfarin management for a median of 2.7 years.
- Time in therapeutic range remained high and stable (90% in phase 1 vs. 92.9% in phase 2, p=0.30).
- No adverse hemorrhagic or thrombotic events occurred; PFUs maintained knowledge and competency, with no significant dosing errors.
Conclusions:
- Empowering patient-family units (PFUs) in warfarin self-management enhances health knowledge and commitment.
- Pediatric warfarin PSM is sustainable, leading to improved adherence and understanding of health conditions.
- PSM of warfarin in children is a safe and effective strategy, positively impacting quality of life.
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