{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:47:41Z","timestamp":1792144061291,"version":"4.4.0"},"reference-count":25,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>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.\nSince 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.\nBy 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\u2122 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\u2019 quality of life.\nThe 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.<\/jats:p>","DOI":"10.4081\/monaldi.2026.4066","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:14:57Z","timestamp":1792142097000},"source":"Crossref","is-referenced-by-count":0,"title":["Reinventing vitamin K antagonist\u00a0therapy management: an implementation study of a home-based integrated monitoring model"],"prefix":"10.4081","author":[{"given":"Margherita","family":"Scapaticci","sequence":"first","affiliation":[{"name":"LUM \u2013 Laboratory Medicine, Maggiore Hospital, Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano","family":"Nigro","sequence":"additional","affiliation":[{"name":"LUM \u2013 Laboratory Medicine, Maggiore Hospital, Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Caveduri","sequence":"additional","affiliation":[{"name":"LUM \u2013 Laboratory Medicine, Maggiore Hospital, Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Mancini","sequence":"additional","affiliation":[{"name":"LUM \u2013 Laboratory Medicine, Maggiore Hospital, Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Bartolini","sequence":"additional","affiliation":[{"name":"LUM \u2013 Laboratory Medicine, Maggiore Hospital, Bologna"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"89198","doi-asserted-by":"crossref","unstructured":"Zirlik A, Bode C. Vitamin K antagonists: relative strengths and weaknesses vs. direct oral anticoagulants for stroke prevention in patients with atrial fibrillation. J Thromb Thrombolysis 2017;43:365-79.","DOI":"10.1007\/s11239-016-1446-0"},{"key":"89199","doi-asserted-by":"crossref","unstructured":"Eikelboom JW, Weitz JI. New anticoagulants. Circulation 2010;121:1523-32.","DOI":"10.1161\/CIRCULATIONAHA.109.853119"},{"key":"89200","doi-asserted-by":"crossref","unstructured":"Amouyel P, Mismetti P, Langkilde LK et al. INR variability in atrial fibrillation: a risk model for cerebrovascular events. Eur J Intern Med 2009;20:63-9.","DOI":"10.1016\/j.ejim.2008.04.005"},{"key":"89201","doi-asserted-by":"crossref","unstructured":"Ageno W, Gallus AS, Wittkowsky A, et al. Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians\u2019 evidence-based clinical practice guidelines. Chest 2012;41:e44S-88S.","DOI":"10.1378\/chest.11-2292"},{"key":"89202","unstructured":"Gobbi B. Healthcare, 24 million chronically ill people in Italy: 60% resort to private visits, 30% forego treatment. 2024. Available from: https:\/\/en.ilsole24ore.com\/art\/health-care-italy-24-million-chronically-ill-60-per-cent-use-private-visits-30-per-cent-forego-treatment-AGLgAxiB."},{"key":"89203","doi-asserted-by":"crossref","unstructured":"Collicelli C. Le criticit\u00e0 della sanit\u00e0 italiana e il necessario cambiamento di paradigma. Recenti Prog Med 2023;114:609-16. [Article in Italian].","DOI":"10.1701\/4097.40944"},{"key":"89204","doi-asserted-by":"crossref","unstructured":"de Ruijter A, Hervey T, Prainsack B. Solidarity and trust in European Union health governance: three ways forward. Lancet Reg Health Eur 2024;46:101047.","DOI":"10.1016\/j.lanepe.2024.101047"},{"key":"89205","unstructured":"Filippini T, Vinceti SR. Italian national recovery and resilience plan: healthcare renaissance? Acta Biomed 2021;92:e2021233."},{"key":"89206","unstructured":"Repubblica Italiana. Piano nazionale di ripresa e resilienza. Available from: https:\/\/www.governo.it\/sites\/governo.it\/files\/PNRR.pdf."},{"key":"89207","unstructured":"Federal Communications Commission. Telehealth, telemedicine, and telecare: what's what? Available from: https:\/\/www.fcc.gov\/general\/telehealth-telemedicine-and-telecare-whats-what."},{"key":"89208","doi-asserted-by":"crossref","unstructured":"Bernstein MR, John L, Sciortino S, et al. Does telehealth improve anticoagulation management in patient service centers (PSC)? A pilot project. J Thromb Thrombolysis 2020;49:316-20.","DOI":"10.1007\/s11239-019-02031-4"},{"key":"89209","doi-asserted-by":"crossref","unstructured":"Franke CA, Dickerson LM, Carek PJ. Improving anticoagulation therapy using point-of-care testingand a standardized protocol. Ann Fam Med 2008;6:S28-32.","DOI":"10.1370\/afm.739"},{"key":"89210","doi-asserted-by":"crossref","unstructured":"Matchar DB, Jacobson A, Dolor R, al. Effect of home testing of international normalized ratio on clinical events. N Engl J Med 2010;363:1608-20.","DOI":"10.1056\/NEJMoa1002617"},{"key":"89211","unstructured":"Descovich C,Foglietta F, Mazzini G. La frontiera avanzata della sanit\u00e0 digitale. Contenuti e processi attuativi di alcune \u00abbuone pratiche\u00bb in telemedicina. Santarcangelo di Romagna, Italy: Maggioli Editore; 2024. [Book in Italian]."},{"key":"89212","doi-asserted-by":"crossref","unstructured":"Gosselin C, Castellone D, Dorgalaleh A, et al. International council for standardization in haematology guidance for new lot verification of coagulation reagents, calibrators, and controls. Semin Thromb Hemost 2024;50:1091-102.","DOI":"10.1055\/s-0043-1776405"},{"key":"89213","unstructured":"Zucker ML, LaDuca FM, Owen R, et al. CLSI POCT14: Point-of-Care Coagulation Testing Guidelines, 2nd ed. Clinical and Laboratory Standards Institute."},{"key":"89214","doi-asserted-by":"crossref","unstructured":"Bussey HI, Rospond RM, Quandt CM, et al. The safety and effectiveness of long-term Warfarin therapy in an anticoagulation clinic. Pharmacotherapy 1989;9:214-9.","DOI":"10.1002\/j.1875-9114.1989.tb04128.x"},{"key":"89215","doi-asserted-by":"crossref","unstructured":"Lip GY, Banerjee A, Boriani G, et al. Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest 2018;154:1121-201.","DOI":"10.1016\/j.chest.2018.07.040"},{"key":"89216","doi-asserted-by":"crossref","unstructured":"White RH. The epidemiology of venous thromboembolism. Circulation 2003:107:I4-8.","DOI":"10.1161\/01.CIR.0000078468.11849.66"},{"key":"89217","doi-asserted-by":"crossref","unstructured":"Kidholm K, Granstr\u00f8m Ekeland A, Jensen LK, et al. A model for assessment of telemedicine applications: mast. Int J Technol Assess Health Care 2012;28:44-51.","DOI":"10.1017\/S0266462311000638"},{"key":"89218","doi-asserted-by":"crossref","unstructured":"Testa S, Paoletti O, Zimmermann A, et al. Telemedicine for managing patients on oral anticoagulant therapy. telemedicine techniques and applications. London, UK: InTech; 2011.","DOI":"10.5772\/19167"},{"key":"89219","doi-asserted-by":"crossref","unstructured":"Heneghan C, Ward A, Perera R, et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet 2012;379:322-34.","DOI":"10.1016\/S0140-6736(12)60758-2"},{"key":"89220","doi-asserted-by":"crossref","unstructured":"Szucs TD, Bramkamp M. Pharmacoeconomics of anticoagulation therapy for stroke prevention in atrial fibrillation: a review. J Thromb Haemost 2006;4:1180-5.","DOI":"10.1111\/j.1538-7836.2006.01890.x"},{"key":"89221","doi-asserted-by":"crossref","unstructured":"Plebani M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem 2010:47:101-10.","DOI":"10.1258\/acb.2009.009222"},{"key":"89222","unstructured":"Oliver P, Fernandez-Calle P, Buno A. POCT accreditation ISO 15189 and ISO 22870: making the point. EJIFCC 2021;32:131-9."}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4066\/2300","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/4066\/2300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:15:00Z","timestamp":1792142100000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/4066"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":25,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2026.4066","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,16]]}}}