INR Point-of-Care Testing: Cost-Effective Self-Monitoring for Anticoagulation Therapy
This overview evaluates point-of-care INR testing as an alternative to traditional laboratory monitoring for patients on vitamin K antagonist therapy. Evidence shows that patient self-testing and self-management achieve outcomes equal or superior to conventional monitoring in terms of haemorrhagic and thrombotic events. A 10-year cost analysis demonstrates that POCT-based anticoagulation management is cost-effective while improving patient convenience and engagement.
The original study
Point-of-care testing INR: an overview.
- Authors
- Barcellona D, Fenu L, Marongiu F
- Journal
- Clinical chemistry and laboratory medicine
- Type
- Journal Article, Review
- PMID
- 27754958
Original abstract
Oral anticoagulant therapies with the anti-vitamin K drugs (AVK), warfarin, acenocoumarol and phenprocoumon, are employed in primary and secondary anti-thrombotic prophylaxis in patients with venous thromboembolism, atrial fibrillation and cardiac mechanical valves. However, a monitoring test such as the International Normalized Ratio (INR) is required. The periodic monitoring of this therapy entails discomfort for the patients. Telemedicine and telecare can provide significant aid in the management of this therapy allowing patients to perform the test at home or anywhere else with a portable device, i.e. point-of-care testing (POCT), and to send the result to a thrombosis (TC) via web. Patients can receive dose adjustment sent back by the TC. The effectiveness of this type of management is equal or superior to the traditional AVK monitoring in terms of hemorrhagic and thrombotic events. Analysis of the costs with a horizon of 10 years reveals that both self-testing and self-management are cost-effective. The aim of this overview is to describe the pros and cons of the use of POCT as an alternative in the monitoring of AVK. In particular, description of the POCT, decentralization, quality of the therapy, safety and costs will be examined.