Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
Thromb Res. 2010 Aug;126(2):e110-5. doi: 10.1016/j.thromres.2010.05.024. Epub 2010 Jun 26.
Increasing numbers of children require warfarin thromboprophylaxis. Home INR testing by the patient (PST) has revolutionized warfarin management. However, the family/patient must contact the health team for guidance for warfarin dosing. Patient self management(PSM) prepares a patient performing PST to take an active role in warfarin dosing. Adult studies demonstrate that PSM is safe and effective with improved adherence and treatment satisfaction quality of life (QOL).
To estimate the safety and efficacy in children performing PSM or PST, to evaluate warfarin dose decision making in PSM, and warfarin related QOL.
Warfarinized children performing PST for >3m were randomized to PST or PSM. The PSM group underwent warfarin management education and assumed independent warfarin management. INRs were collected for a year prior to and for 1 year of study to determine TTR and warfarin decision making. QOL was assessed through inventory completion and interviews.
28 children were randomized and followed for 12 months. TTR was (83.9% pre/ post), and 77.7% pre to 83.0% post for PST and PSM (p=0.312). Appropriate warfarin decision making was 90% with no major bleeding episodes and no thromboembolic events. PSM was preferred by families.
PSM for children may be a safe and effective management strategy for warfarinized children. Clinical studies with larger sample size are required.
越来越多的儿童需要华法林预防血栓。患者在家进行 INR 检测（PST）彻底改变了华法林的管理方式。但是，患者家庭必须联系医疗团队以获得华法林剂量指导。患者自我管理（PSM）使接受 PST 的患者能够积极参与华法林的剂量调整。成人研究表明，PSM 是安全有效的，能够提高患者的服药依从性和治疗满意度，改善生活质量（QOL）。
评估儿童患者进行 PST 或 PSM 的安全性和有效性，评估 PSM 中的华法林剂量决策，以及与华法林相关的 QOL。
接受 PST 超过 3 个月的华法林化儿童被随机分配至 PST 或 PSM 组。PSM 组接受华法林管理教育并承担独立的华法林管理。在研究的前一年和一年中收集 INR，以确定 TTR 和华法林决策。通过问卷调查和访谈评估 QOL。
28 名儿童被随机分组并随访 12 个月。TTR 为（83.9% 治疗前/后），PST 和 PSM 分别为 77.7%治疗前至 83.0%治疗后（p=0.312）。适当的华法林决策率为 90%，无大出血事件和血栓栓塞事件。家庭更喜欢 PSM。
PSM 可能是一种安全有效的华法林治疗儿童的管理策略。需要更大样本量的临床研究。
