Home INR Self-monitoring — EECC MCQ

Correct answer: A — Patient self-monitoring (PSM) or self-management (PSA) of warfarin INR at home improves time in therapeutic range and reduces thromboembolic events compared with clinic-based monitoring — it is recommended (Class IIa) for motivated patients after appropriate training

Home INR monitoring using point-of-care coagulometers allows: (1) patient self-monitoring (PSM) — patient measures INR and reports to clinic for dose adjustment; or (2) patient self-management (PSA) — patient measures AND adjusts warfarin dose based on a trained algorithm. Meta-analyses (including the PROACT study) show that home INR monitoring: improves time in therapeutic range (TTR), reduces major thromboembolic events (by ~50%), and may reduce mortality compared with clinic-based monitoring. The 2025 ESC VHD Guidelines recommend PSM or PSA for patients on warfarin for mechanical valves (Class IIa), provided adequate training, cognitive ability, and manual dexterity are present. Devices require regular quality control. This approach empowers patients and is particularly valuable for those in rural areas or with limited clinic access.

Reference: ESC/EACTS (2025): VHD Guidelines; PROACT Study