Ino Naomi, Masutani Satoshi, Tanikawa Shoyo, Iwamoto Yoichi, Saiki Hirofumi, Ishido Hirotaka, Tamura Masanori, Senzaki Hideaki
Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
J Cardiol. 2018 Feb;71(2):187-191. doi: 10.1016/j.jjcc.2017.07.006. Epub 2017 Oct 21.
Warfarin administration is essential but requires difficult management and frequent clinic visits in patients with mechanical prosthetic atrioventricular valve replacement (MPAVVR). This study investigated how home prothrombin international ratio (PT-INR) monitoring with CoaguChek (Roche Diagnostics, Basel, Switzerland) safely reduced clinic visits in children with MPAVVR. We also compared individual correlations between the CoaguChek and laboratory PT-INR.
This study included four pediatric patients who started frequent warfarin home-monitoring after MPAVVR (three mitral valves and one tricuspid valve). We collected information regarding the number of outpatient clinic visits and measurements of PT-INR before and after starting home CoaguChek monitoring (each one year) from medical records. We also compared individual correlations between laboratory and CoaguChek PT-INR in three patients.
No major clinical events were encountered during the study period. The ratio of outpatient clinic visits in the second year to those in the first year was decreased in all patients (0.30-0.66). The ratio of the numbers of home measurements to all PT-INR measurements in the second year ranged from 0.55 to 0.64 indicating that CoaguChek home monitoring approximately halved the number of outpatient clinic visits. CoaguChek measurements tended to be slightly overestimated in two patients but were greatly underestimated in one patient.
CoaguChek home monitoring in children with MPAVVR reduced the number of their clinic visits without compromising the safety of warfarin management. Given considerable individual differences in correlations between CoaguChek and laboratory PT-INR, individual correlation needs to be identified to fairly interpret the CoaguChek PT-INR values.
对于接受机械性人工房室瓣膜置换术（MPAVVR）的患者，华法林治疗至关重要，但管理难度大且需要频繁门诊就诊。本研究调查了使用CoaguChek（罗氏诊断公司，瑞士巴塞尔）进行家庭凝血酶原国际标准化比值（PT-INR）监测如何安全减少MPAVVR患儿的门诊就诊次数。我们还比较了CoaguChek与实验室PT-INR之间的个体相关性。
本研究纳入了4例MPAVVR术后开始频繁家庭华法林监测的儿科患者（3例二尖瓣置换和1例三尖瓣置换）。我们从病历中收集了开始家庭CoaguChek监测前后（各1年）的门诊就诊次数及PT-INR测量值的信息。我们还比较了3例患者实验室与CoaguChek PT-INR之间的个体相关性。
研究期间未发生重大临床事件。所有患者第二年门诊就诊次数与第一年的比值均下降（0.30 - 0.66）。第二年家庭测量次数与所有PT-INR测量次数的比值范围为0.55至0.64，表明CoaguChek家庭监测使门诊就诊次数减少了约一半。两名患者的CoaguChek测量值倾向于略有高估，但一名患者的测量值被大幅低估。
MPAVVR患儿使用CoaguChek家庭监测可减少门诊就诊次数，且不影响华法林治疗的安全性。鉴于CoaguChek与实验室PT-INR之间的相关性存在相当大的个体差异，需要确定个体相关性以准确解读CoaguChek PT-INR值。
