Self-testing of the International Normalized Ratio in adults with a mechanical heart valve: Patient education and cost matter

Replacement of a heart valve with a mechanical prosthesis mandates life-long anticoagulation treatment. Many studies have confirmed that close INR testing along with adapted therapeutic education of patients is a good option to reduce the occurrence of complications and their recurrence. It is safe and effective, particularly in selected and successfully trained patients, such as patientswho are frequently away fromhome,who are in school, or those who find it difficult to travel to clinics. An important question that has not been adequately addressed in the literature is, whether outside clinical trials, patients should continue to use INR self-testing devices at home despite the financial cost of their utilization. The latest developments in the patient education and the ongoing research in pharmacology and molecular biology should allow patients to better understand their care pathway, drug therapy and its associated complications. In turn, once patient adhesion is achieved, such as what was obtainedwith the Azarnoush et al. strategy, INR self-testing devices should be increasingly disseminated.