Q: My father is taking anticoagulants to maintain his replaced heart valve. His prothrombin time/INR has been quite erratic off late and requires very close PT monitoring. It is understood that an instrument to measure PT/INR is available in the market which can be used by the patient himself. Please advice where in India, will this be available and indicate the price?

A:Clinical studies suggest that home PT monitoring is more effective than uncoordinated management and is as effective as care through specialized anticoagulation clinics for keeping INRs within a therapeutic range. There are accurate and reliable instruments available, but paramount to the success of home PT monitoring is sound patient selection, appropriate patient training, and consistent quality control. The studies evaluating the use of portable PT monitors indicate that the monitors are accurate and can be used appropriately by selected patients with adequate training who are motivated to perform self-testing. As yet there are no comprehensive quality assurance (QA) programs to check the performance of the instruments. Ideally monitors should be recalled periodically to the clinic where they have been prescribed to the patient. During each visit, the clinic may check the monitors and patient self- testing performance as described. Such comprehensive QA system would make monitoring of oral anticoagulant treatment by self-testing safer and more effective. The U.S. Food and Drug Administration (FDA) has approved portable testing devices that are available by prescription for home use such as: