EKITE phase 2: A valuable readily available resource for patient education on thrombosis and warfarin anticoagulation therapy

Long-term anticoagulation (LTA) is a chronic therapy. Like many chronic therapies, the foundation of effective LTA management lies in developing and maintaining patient knowledge about the treatment. Children and their families often struggle to understand and stay motivated to ensure safe and effective therapy, which includes routine monitoring. This study aims to evaluate the effectiveness of the electronic KidClot interactive Thrombophilia Education (eKITE) Warfarin web-based training modules in reinforcing and enhancing anticoagulation knowledge for children on long-term warfarin and their families as part of routine clinical follow-up by KidClot/Stollery Children's Hospital.

Methods: This prospective study utilized the eKITE Warfarin series (thrombosis, safety of anticoagulation, lab INR, and home INR testing) as an annual requirement for patients on warfarin as part of their ongoing clinical care. This approach aimed to refresh and build knowledge about warfarin and educate those transitioning to warfarin self-management. Patients conducted INR testing at home using a coagulometer or visited the laboratory for venipuncture INR testing. Children and their families accessed online warfarin education from home. Participants completed eKITE modules, quizzes, and surveys to assess and reinforce their warfarin knowledge. The validated Patient Preference Survey assessed patient preferences for learning styles. The State Anxiety Score was used to evaluate patient stress and anxiety related to learning warfarin management, while the KidClot PAC QL assessed warfarin's impact on quality of life. INRs were collected, and time in therapeutic range was calculated.

Results

A total of 136 children on warfarin participated; twenty-nine (21 %) underwent laboratory INR testing, while 107 (79 %) performed INR tests at home using the CoaguChek XS INR meter. The primary indication for long-term warfarin therapy was an underlying cardiac disorder with varied INR target ranges. Yearly mean follow-up knowledge scores were 84(IQR 70–100) and 90(IQR 80–100) at 6 and 18 months post-enrollment, respectively. The time in therapeutic range was 70.1(IQR 63–76) and 70.5 (IQR 57–74 for self-testing and self-management at 18 months post-enrollment. Stress-related to learning decreased, and health-related quality of life (HrQOL) improved over the study period.

Conclusion

eKITE is a practical, cost-effective, readily available, diverse online education series that teaches and provides always-available resources to children and families about thrombosis and anticoagulation, supporting knowledge and improving HrQOL.