EMPoWarMENT: Edmonton Pediatric Warfarin Self-Management Pilot Study in Children with Primarily Cardiac Disease

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). Objective: To estimate the safety and efficacy in children performing PSM or PST, to evaluate warfarin dose decision making in PSM, and warfarin related QOL. Methods: Warfarinized children performing PST for >3 m 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. Results: 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. Conclusions: PSM for children may be a safe and effective management strategy for warfarinized children. Clinical studies with larger sample size are required. (C) 2010 Elsevier Ltd. All rights reserved.