Key result
Patients using a portable coagulation monitor for home INR self-management after mechanical valve replacement achieved a higher time in therapeutic range (0.76 vs 0.72) compared to routine outpatient monitoring.
Why the study?
Portable coagulation monitors enable patient self-management of INR, but their safety and efficacy evaluated by time in therapeutic range needed evaluation in patients receiving warfarin after left-sided mechanical prosthetic valve replacement.
Does the use of a portable coagulation monitor for home INR self-management improve time in therapeutic range and reduce complications compared to conventional outpatient monitoring in patients with left-sided mechanical prosthetic valves on warfarin?
Cohort (n=212)
No
Does the use of a portable coagulation monitor for home INR self-management improve time in therapeutic range and reduce complications compared to conventional outpatient monitoring in patients with left-sided mechanical prosthetic valves on warfarin?
Absolute Event Rate: 0.76% vs 0.72%
p-value: p=0.19
Home INR self-management using a portable coagulation monitor is safe and facilitates more frequent testing, potentially improving anticoagulation control in patients with mechanical prosthetic valves.
Home self-monitoring was associated with higher TTR; leaves open whether it reduces complications in mechanical valve patients.
BACKGROUND: Time in therapeutic range (TTR) is an index to assess the effectiveness of anticoagulation and is important to predict the risk of bleeding and thrombosis in patients taking warfarin. In recent years, the portable coagulation monitor, a point-of-care testing device for patients to perform self-management international normalized ratio (INR) examination, has provided an opportunity to improve the quality of oral warfarin treatment. In this study, we applied TTR to evaluate the safety and efficacy of the portable coagulation monitor for patients with oral anticoagulant warfarin after left-sided mechanical prosthetic valve (MPV) replacement. METHODS: It is a single-centre cohort study. From September 2019 to June 2021, a total of 243 patients who returned to our institution for outpatient clinic revisit at 3 months after left-sided MPV replacement, met the inclusion criteria and agreed to be followed up were included. Self-management group used portable coagulation monitor for INR examination, and patients in the conventional group had their INR monitored in routine outpatient visits. Clinical data of the patients would be recorded for the next 12 months, and results were compared between the two groups to assess the effect of the coagulation monitor on TTR and complications related to bleeding and thrombosis in patients with left-sided MPV replacement. RESULTS: A total of 212 individuals provided complete and validated INR data spanning of 1 year. Those who applied the portable coagulation monitor had higher TTR values and larger number of tests for INR. No significant differences were seen between the two groups in postoperative bleeding and thromboembolic complications, but portable coagulation monitor showed a trend toward fewer bleeding events. CONCLUSION: Portable devices for coagulation monitoring are safe and can achieve a higher TTR. Patients who use the portable coagulation monitor for home INR self-management can achieve a safe and effective warfarin therapy.
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Shen et al. (2022) conducted a cohort in Left-sided mechanical prosthetic valve replacement (n=212). Portable coagulation monitor for INR self-management vs. Routine outpatient clinic visits for INR monitoring was evaluated on Time in therapeutic range (TTR) (p=0.19). Patients using a portable coagulation monitor for home INR self-management after mechanical valve replacement achieved a higher time in therapeutic range (0.76 vs 0.72) compared to routine outpatient monitoring.
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