Evaluation of self-testing INR in a French GUCH population with mechanical valve - 06/01/20
Résumé |
Background |
The Coaguchek INRange® is a self testing meter to measure the INR, that is reimbursed by French Social Security since August 2017 for patients with mechanical valve.
Methods |
We evaluated the use of this anticoagulation method in a French population of GUCH (Grown-Up patients with Congenital Heart Disease) with mechanical valve.
Results |
Since September 2018, 52 patients of 37±11 years old were asked to attend a training of 2hours on anticoagulation and Coaguchek INRange® use, provided by specialized nurses, before getting home with the machine. Patients had to attend a 3 months re-evaluation appointment. Twenty-nine (56%) patients had an aortic mechanical valve, 12 (23%) a mitral one, 8 (15%) a double aortic and mitral one, 2 (4%) a double aortic and pulmonary one and 1 (2%) a tricuspid one. 28 patients (54%) had a mechanical valve for ≥10 years (group 1). In group 1, patients were older (41±10 years old vs. 34±10, P=0.01). Fluindione was the preferred oral anticogulant (30 patients, 57%), and more frequent in group 1 (18 patients, 64%). In group 1, 61% of patients usually managed themselves dosage adjustment whereas in the other group, 52% of patients referred to their doctor. Thirty-one patients (62%) had a higher target of INR than recommended in the last European guidelines. Concerning follow-up, 26 patients (50%) did not attend the 3 months appointment and had to be rescheduled or contacted by phone. Eight patients (15%) did not use the device at 3 months: 5 for variation >15% compared to laboratory plasma technique and 3 for not trusting the new device. INR at 3 months was obtained in only 40 (77%) patients, and was in the attended target in 62% of cases.
Conclusion |
GUCH patients with mechanical valves, especially when present for ≥10 years, seem to validate Coaguchek, even though evaluation is hard since a great proportion of them did not attend follow-up appointment, stick to their old INR target and did not use the device as often as recommended.
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Vol 12 - N° 1
P. 170 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.