Stefan Klimach*
Brighton & Sussex Medical School*
A best evidence topic in paediatric cardiothoracic surgery was written according to a structured protocol. The question addressed was: In children requiring long term anticoagulation, is home patient testing of INR safer than clinic-based INR testing?

A total of 306 papers were identified using the reported search protocol, of which seven original articles represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated.

All of the nine studies demonstrated that home INR testing in children had comparable safety to hospital testing, with low rates of complications and high degrees of accuracy of INR estimation, regardless of which model of portable monitor is used. One of nine articles showed that regular, routine home testing of INR values in children on anticoagulation therapy may in fact be safer than in-clinic testing, as illustrated by a higher median INR values in the safe therapeutic range in children tested at home.

Therefore, the clinical bottom line is that home INR testing is as safe as hospital INR testing for children on long-term oral anticoagulation, provided that accurate portable monitors are combined with a rigorous education scheme for the children and their parents.
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