T E C H N I C A L B U L L E T I N 11 1
Point Of Care Anticoagulation Monitoring In Pediatric Patients
The relatively recent successes in tertiary care of critically ill children have increased the frequency of long term secondary The most commonly used medications in children that affect the complications resulting in an increasing use of warfarin for both primary and secondary prophylaxis.1, 2 Warfarin can be used safely if administered and monitored carefully. Monitoring oral anticoagulation therapy (OAT) in children is Commonly Used Drugs in Children
difficult and requires close observation with frequent dose That Affect Their INR Values
adjustments. In contrast to adults, only 10 to 20% of children can
Effect of INR
be safely monitored monthly, hence require higher frequency of Whole blood monitors use various techniques to measure the INR (International Normalized Ratio). These devices have been shown to be acceptable and reliable for use in the outpatient The major advantages identified by patient families included • Smaller sample volume compared to phlebotomy. • Minimal interruption of school and work. • Immediate result as compared to long waits to get results Conclusion:
• More frequent INR measurements lead to an increased percentage of INR values within the target range and the use There are many important variables that make the use of of whole-blood monitors may assist in maintaining INR values anticoagulant drugs in pediatric patients, different from the use of the same drugs in adults. These variables contribute to the • The proven reliability and accuracy of the results obtained need for more frequency of testing and are listed as below 1:
from whole blood monitors and the short turn around time for • The epidemiology of diseases in pediatric patients is vastly • The parent directed or self-managed adolescent patients tend • The response to anticoagulant drugs may be different in to test themselves more frequently than patients who only use an anticoagulant clinic, which can improve clinical outcome. • The distribution, binding and clearance of anticoagulant • Many families prefer the portable monitor because they are emotionally less traumatic for their child, eliminating • The frequency and type of inter-current illnesses and laboratory waiting room anticipation for toddlers. • Other advantages include minimal interruption of work and • There are no pediatric specific formulations of anticoagulant drugs, making accurate, reproducible, weight adjusted dosing difficult, thus impacting the ability to monitor. References:
1. Mongale P, Chan A, Massicotte P, Chlamers E, and Michelson D. Chest • Dietary differences make the use of oral anticoagulant drugs particularly difficult, especially in infants because infant 2. W. Streif, M. Andrew, V, Marzinotto, P. Massicotte, A.K.C. Chan, J.A. formulas have different levels of vitamin K. Julian, and Mitchell. Analysis of Warfarin therapy in pediatric patients. 3. Massicotte P, Marzinotto V, Vegh P, et al. Home monitoring of Warfarin Compliance issues are vastly different in pediatric therapy in children with a whole blood monitor. J Pediatr 1995; 127:389- a. Younger population does not understand the
4. Nowatzke W, Landt M, Smith C, et al. Whole blood international normalization ratio measurements in children using near patient b. Adolescents who intellectually may comprehend
monitors. J Peadiatr Hematol Oncol 2003;25:33-37 but are emotionally unable to cooperate, and 5. Marzinotto V, Mongale P, Chan A, et al. Capillary whole blood c. Children in dysfunctional families experiencing
monitoring of oral anticoagulation in children in outpatient clinics and non-compliance due to inadequate parenting the home setting. Pediatr Cardiol 2000;21:347-352 Most children taking anticoagulants are receiving multiple 6. Andrew M, Marzinotto V, Booker L, et al, oral anticoagulant therapy in medications, both on a long term basis, to treat their primary pediatric patients: a prospective study. Thromb Haemost 194; 71:265-269 7. Hirsh J. Oral anticoagulant drugs: review article. N Engl J Med 1991; problems, or intermittently, to treat acquired problems (eg infections). These medications influence the dose requirements 8. Michelson AD. Bovill E, Andrew M. Antithrombotic therapy in children HemoSense, Inc. 651 River Oaks Parkway, San Jose, CA 95134 1-877-436-6444 toll free (408)719-1393 tel (408)719-1184 fax www.hemosense.com 2006 HemoSense, Inc. All rights reserved. 0200379 RevB

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