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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

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.

warfarin
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.

thinrs
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.

thinrs primary outcome
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.

thinrs total events by intervention
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.