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The Home INR Study (THINRS): Home INR Monitoring as Effective as Clinic-Based Care

The Home INR Study (THINRS): Home INR Monitoring as Effective as Clinic-Based Care. AK Jacobson, MD American Heart Association 2008 Scientific Sessions: Abstract 5217 S. Jeffrey Medscape Medical News, November 13, 2008. Warfarin.

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The Home INR Study (THINRS): Home INR Monitoring as Effective as Clinic-Based Care

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  1. The Home INR Study (THINRS): Home INR Monitoring as Effective as Clinic-Based Care AK Jacobson, MDAmerican Heart Association 2008 Scientific Sessions: Abstract 5217 S. JeffreyMedscape Medical News, November 13, 2008.

  2. Warfarin • Warfarin is an effective anticoagulation therapy if managed well • Underutilized • Quality of management can be poor • Needs frequent testing to ensure efficacy • International normalized ratio (INR) monitoring • Home INR testing may improve patient outcome • Allows for rapid detection and correction of out-of-target-range INRs • Promotes engagement of patients S Jeffrey. AHA 2008: THINRS: Home INR Monitoring as Effective as Clinic-Based Care. Medscape Medical News, Nov. 13, 2008.

  3. THINRS • Comparison of two strategies • Weekly patient self-testing (PST) using interactive voice-response reporting and web-based local monitoring • Currently recommended practice: high-quality anticoagulation management (HQACM) monthly at a clinic • 2922 VA patients with atrial fibrillation or mechanical valves • Average warfarin dose of 5 mg/day • Primary endpoint: stroke, major bleeds, and death S Jeffrey. AHA 2008: THINRS: Home INR Monitoring as Effective as Clinic-Based Care. Medscape Medical News, Nov. 13, 2008.

  4. THINRS Primary Outcome • Consistent trend toward benefit for PST on all components of primary endpoint • No evidence of harm in patient self-testing S Jeffrey. AHA 2008: THINRS: Home INR Monitoring as Effective as Clinic-Based Care. Medscape Medical News, Nov. 13, 2008.

  5. THINRS: Total Events by Intervention • Over 7% improvement in PST over HQACM in time in the target INR range • Duke Anticoagulation Satisfaction Scale showed higher satisfaction with anticoagulation in the PST group • Health Utilities Index demonstrated more improvementin PST group • Home testing is an acceptable alternative to clinic care • May be preferable where patient access is difficult S Jeffrey. AHA 2008: THINRS: Home INR Monitoring as Effective as Clinic-Based Care. Medscape Medical News, Nov. 13, 2008.

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