Reinventing vitamin K antagonist therapy management: an implementation study of a home-based integrated monitoring model.

Abstract

Vitamin K antagonist (VKA) oral anticoagulant therapies are crucial for preventing thromboembolic complications in cardiovascular diseases; however, their narrow therapeutic range necessitates frequent monitoring of the International Normalized Ratio (INR), posing significant challenges for elderly and frail patients. This article presents the implementation of a new home-based monitoring model for VKA therapy that integrates digital tools with clinical supervision. Since 2022, the Local Health Authority of Bologna (Italy) has implemented a home-based coagulation diagnostics model to improve VKA management, consisting of an INR PoCT Network that integrates hospital and community services through a digital system that streamlines data collection and oversight. Portable devices, supervised by laboratory personnel, provide home-based results comparable to central laboratory standards, improving workflows and enabling timely clinical decisions. By 2024, the INR PoCT Network comprises 17 home care units serving 1,701 patients. Approximately 20,000 blood samples are processed each year, with further growth expected. Nurses perform INR testing using the Xprecia Prime™ analyzer (Universal Biosensors Inc.), and results undergo automated self-verification based on algorithms aligned with central laboratory procedures, ensuring accuracy and reliability. A digital report is generated to support timely therapy adjustments and follow-up. This model reduces Turn Around Time for coagulation results from more than three hours to about 20 minutes, improves monitoring effectiveness, decreases hospital visits, and enhances patients' quality of life. The system demonstrates that investing in home monitoring improves comfort, reduces healthcare burden, and modernizes VKA therapy management through a scalable, accurate, and patient-centered approach.