In this environment, 28-day long-acting penicillin prophylaxis for at least 10 years delivered by community nurses is safe and effective for patients with no or mild cardiac disease by auscultation at discharge off penicillin. Penicillin delivery every 21 days (as suggested by a recent Cochrane review) would add to costs and complexity.

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anticoagulation is to ensure that treatment is effective and safe in preventing thromboembolism, and is without haemorrhagic complications. In patients with the Fontan circulation, the incidence of thromboembolism is reported as between 3 and 16 percent by retrospective studies. 1 In patients with a single mechanical valve not receiving any antithrombotic therapy, the risk of thromboembolism is between 5.7 and 20 percent per patient-year, depending on the site and type of valve. 2-4 With anticoagulation, the risk of thromboembolism is less than 5.3 percent per patient-year, 5 and the risk of serious haemorrhage is less than 3.2 percent per patient-year. 6 Furthermore achieving optimal anticoagulation in children with cardiac disease involves many complexities. Streif et al. 7 have demonstrated the profound effect of young age, and the effect of congenital cardiac disease, in particular the Fontan circulation, on dosages of warfarin. Antithrombotic therapy in children is also affected by recurrent infection, issues of compliance, Abstract Objective: To assess the impact of a computerised system to support decision-making concerning the management of warfarin used in maintenance of anti-coagulation. Design: Retrospective case series study comparing manual and computerised records of prescribing. Setting: A tertiary paediatric cardiology department in a teaching hospital. Participants: The 26 children receiving warfarin to maintain anticoagulation at the time of introduction of a computerised system to support decision-making. Interventions: A rules-based computerised system to support decisions, based on existing departmental guidelines, for management of anticoagulation using warfarin was introduced to aid prescribing physicians. Main outcomes: We assessed the stability of the International Normalised Ratio, along with the number of checks made of the ratio, and the adjustments of dosage. Dosages, and recheck interval prescriptions, were compared to the guidelines established by our department. Results: We compared 274 prescriptions made manually, and 608 made using the computerised system to support decision-making, covering periods of 4, and 11, months respectively. The mean proportion of time spent by the patients within their target range for the International ratio was maintained during the period studied, at 76 percent versus 79 percent (p ϭ 0.79). The median number of checks of the ratio made for each patient over a period of 28 days was unchanged, at 1.9 versus 2.1 (p ϭ 0.58). There was a significant change in prescribing practices, which more closely followed the departmental guidelines. Conclusion: The introduction of a computerised system to support decision-making maintained the stability of the International ratio using warfarin, without increasing the number of checks or adjustments of dosages, in a point-of-care service for anticoagulation in children.