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). Bauman and colleagues sought to estimate the safety and efficacy in children performing PSM or PST, to evaluate warfarin dose decision making in PSM, and warfarin related QOL. Warfarinized children performing PST for >3m 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 1year of study to determine TTR and warfarin decision-making. QOL was assessed through inventory completion and interviews. A total of 28 children were randomized and followed for 12months. 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. Families preferred PSM.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that PSM for children might be a safe and effective management strategy for warfarinized children. Clinical studies with larger sample size are required.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER: The conclusions are prudent: The results suggest that studies with larger numbers of patients should be taught self-management skills. It appears to be a hold promise to many diabetic children taking warfarin. It would be great if the patients were followed for more than two years.

ME Bauman, et al. EMPoWarMENT: Edmonton Pediatric Warfarin Self-Management Pilot Study in Children with Primarily Cardiac Disease. Thrombosis Research, June 26, 2010.