Abstract Number: PB1268
Meeting: ISTH 2020 Congress
Background: Anticoagulant treatment with vitamin K antagonist is increasing in children diagnosed with congenital heart diseases. As international normalized ratio fluctuations are frequent in pediatric population, a suboptimal time in therapeutic range (TTR) has been usually described. Self-management programs have demonstrated to be useful increasing TTR in this field.
Aims: The aim of this study is to evaluate the sustainability and the improvement of TTR over time by using self-management of oral anticoagulation with vitamin K antagonist in a pediatric series.
Methods: A prospective cohort study was conducted in a series of pediatric patients during three years in order to evaluate the evolution of TTR over time. Filiation data, anticoagulant treatment indication and data from self-management program were collected. Physicians and nurses evaluated TTR, which was calculated in periods of six months. When bad compliance was suspected, an educational reinforcement appointment was performed.
Results: A total of 60 patients were evaluated. Total follow up was of 148.28 patient-years and mean (SD) follow-up was 2.36 ± 0.65 years (range 0.42 – 3.00 years). The overall incidence of serious complications was 1.34% patient-year (CI 1.1 – 1.94). Global TTR evaluation showed a statically relevant improvement >80% (p< 0.05), but this result was not achieved in small children (1-6 years old) and in patients whose INR target was 2.5 to 3.5, final TTR in those groups was > 73% (figure 1). Table 1 shows the number of patients with TTR below 60% due to medical conditions. When bad adherence to treatment or to self-management was suspected, a reinforcement of the educational program was scheduled. TTR in the following period was specifically evaluated in those cases.
Conclusions: Self-management is an adequate tool to control vitamin K antagonist, but periodically assessment of self-management program helped patients to improve the efficacy of anticoagulation.
| Period 1 Jul-Dec 16 | Period 2 Jan-Jun 17 | Period 3 Jul-Dec 17 | Period 4 Jan-Jun 18 | Period 5 Jul-Dec 18 | Period 6 Jan-Jun 19 | |
| Patients TTR 80-100% (n,%) | 10 (47.7) | 20 (43.5) | 27 (52.9) | 30 (53.6) | 25 (42.4) | 37 (61.7) |
| Patients TTR 60-80% (n,%) | 7 (33.3) | 18 (39.1) | 16 (31.4) | 17 (30.3) | 27 (45.7) | 20 (33.3) |
| Patients TTR 40-60% (n,%) | 2 (9.5) | 7 (15.2) | 8 (15.7) | 7 (12.5) | 6 (10.2) | 3 (5) |
| Patients < 40% (n,%) | 2 (9.5) | 1 (2.2) | 0 | 2 (3.6) | 1 (1.7) | 0 |
| TRR <60% explained by medical conditions (n) | 1 | 3 | 6 | 4 | 2 | 3 |
| Educational program reinforcement when TTR < 60% (n) | 3 | 5 | 2 | 4 | 4 | 2 |
| Patients who improve (TTR >60%) following 2nd educational program (n) | 3 | 4 | 2 | 2 | 2 | – |
| Number and TTR of patients initiating self-management program | n=21 75.04 +/- 20.1 | n=25 72.24 +/- 19.7 | n=5 65.56 +/- 17.9 | n=5 63.74 +/- 21.7 | n=3 79.68 +/- 7.0 | n=1 – |
[Table 1. TTR ranges for each period in all patients and in those cases initiating the self-management program. Patients whose TTR <60% was explained b]
[Figure 1. TTR for all patients and in the different INT target and age groups of patients.]
To cite this abstract in AMA style:
Berrueco R, Benedicto C, Ruiz-Llobet A, Solsona M, Mesegue M, Gassiot S. Self-Management of Oral Anticoagulation with Vitamin K Antagonist Programs Progressively Improves Time in Therapeutic Range in Pediatric Population [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/self-management-of-oral-anticoagulation-with-vitamin-k-antagonist-programs-progressively-improves-time-in-therapeutic-range-in-pediatric-population/. Accessed October 1, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/self-management-of-oral-anticoagulation-with-vitamin-k-antagonist-programs-progressively-improves-time-in-therapeutic-range-in-pediatric-population/