The Home INR Study (THINRS): Home INR Monitoring as Effective as Clinic-Based Care AK Jacobson, MD American Heart Association 2008 Scientific Sessions:

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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 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 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 Risk for Death, Major Bleeds, or Stroke with Home-Based vs. Clinic INR Testing End PointHazard Ratio95% CIP Time to first event 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 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 improvement in PST group Home testing is an acceptable alternative to clinic care – May be preferable where patient access is difficult EventsHQACM (%)PST (%) Stroke Major bleed Death Total events S Jeffrey. AHA 2008: THINRS: Home INR Monitoring as Effective as Clinic-Based Care. Medscape Medical News, Nov. 13, 2008.