Self-monitoring of oral anticoagulation: 2022–2025 monocentric experience with COAGUCHEK®

Authorized since 2008 for children under 18, reimbursement of INR self-measurement analyzers and their consumables was extended in 2017, due to the failure of direct oral anticoagulants to adult patients with mechanical heart valves. In 2021, the ESC/EATS guidelines for the management of valvular heart disease validated the use of INR self-monitoring. To create an active file of patients with a valvular mechanical prosthesis treated with VKA, likely to benefit from personalized education in self-monitoring of INR (COAGUCHEK®) and evaluate its characteristics. Therapeutic education sessions combined training seminars on INR self-monitoring, personalized self-measurement with practical support from specialist nurses, cardiologists and biologists, and INR monitoring at the laboratory centre. Collected data are analyzed. From January 2022 to February 2025, 116 patients were approached. 108 patients (mean age: 54 years – 20 to 84 years) attended one of 19 training sessions on self-measurement of INR. Each half-day session was attended by 4 to 8 patients. Two patients required a second training session. The indication for VKA treatment was aortic prosthesis ( n = 47; 47.5%), mitral prosthesis ( n = 33; 30.5%), mitro-aortic prosthesis ( n = 10; 9.25%), Bentall prosthesis ( n = 14; 12.9%), and congenital pathology ( n = 4; 3.7%). The anticoagulant treatment was coumadin ( n = 50, 46.3%), fluindione ( n = 47, 43.5%) and acenocoumarol ( n = 11, 10.2%). The mean time between cardiac surgery and self-measurement training was 13 years (6 months to 42 years). The comparison performed within a 90-minute interval between INR obtained by self-testing and the INR measured by the laboratory analyzer showed concordance in 85.2% of cases and discordance for 16/108 (14.8%) patients. A discrepancy required a new self-measurement and a clinical-biological investigation. The training satisfaction rate was excellent (92/108; 89.8%), good (9/108; 8.3%), insufficient (2/108; 1.8%). This single-centre trial from 2022 to 2025 of self-measurement of INR in comparison with a reference laboratory highlights the variety of valvular and congenital pathologies involved, the absence of an age limit, the ease for the patient to learn the self-measurement technique and the incentive for regular monitoring of INR.