[Self-management of oral anticoagulant therapy in children with congenital heart defects]. / Selvstyring af peroral antikoagulationsbehandling hos børn med medfødte hjertesygdomme.

INTRODUCTION: Self-management of oral anticoagulation has been shown to produce a better quality of treatment than conventional management when assessed in selected adults. We have extended the concept of self-management to include children with congenital cardiac disease on the hypothesis that it is also possible in this subset of patients. Our aim was to assess the quality of self-management in children with congenital cardiac disease. MATERIAL AND METHODS: We trained 14 children aged from 2.2 to 15.6 years, with a mean age of 9.7 years, and their parents, in domiciliary analysis of the international normalised ratio (INR) and the necessary dose adjustment of the oral anticoagulant therapy. The curriculum for training covered 27 weeks, and the patients and their parents were followed up for a period of up to 31 months by weekly measurement of the INR values obtained. RESULTS: The patients were observed over a mean of 547 days (range: 214-953 days). They were within the therapeutic targeted range of the INR for a median of 65.5% of the time (range: 17.6-90.4%. None of the patients experienced thromboembolic or bleeding complications requiring doctoral intervention. All the patients and their parents expressed full satisfaction with the treatment. DISCUSSION: Self-management of oral anticoagulation provides a good quality of treatment and is safe and feasible in selected children with congenital cardiac disease.