Evaluation of the i-STAT point-of-care capillary whole blood prothrombin time and international normalized ratio: Comparison to the Tcoag MDAII coagulation analyzer in the central laboratory

2012 ◽  
Vol 413 (11-12) ◽  
pp. 955-959 ◽  
Author(s):  
J.A. Peña ◽  
K.B. Lewandrowski ◽  
E.L. Lewandrowski ◽  
K. Gregory ◽  
J.M. Baron ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Whole Blood ◽  
Point Of Care ◽  
International Normalized Ratio ◽  
Central Laboratory ◽  
Coagulation Analyzer

scholarly journals Point-of-care coagulation testing for reducing in-hospital delay in thrombolysis

2018 ◽  
Vol 26 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Jung Hee Han ◽  
Seongsoo Jang ◽  
Mi-Ok Choi ◽  
Mi-Jeong Yoon ◽  
Seung-Bok Lim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prothrombin Time ◽  
Laboratory Testing ◽  
Point Of Care ◽  
Intravenous Thrombolysis ◽  
International Normalized Ratio ◽  
Interquartile Range ◽  
Time Interval ◽  
Central Laboratory ◽  
Point Of Care Testing

Background: The confirmation of prothrombin time international normalized ratio by a central laboratory often delays intravenous thrombolysis in patients with acute ischemic stroke. Objectives: We investigated the feasibility, reliability, and usefulness of point-of-care determination of prothrombin time international normalized ratio for stroke thrombolysis. Methods: Among 312 patients with ischemic stroke, 202 who arrived at the emergency room within 4.5 h of stroke onset were enrolled in the study. Patients with lost orders for point-of-care testing for the prothrombin time international normalized ratio or central laboratory testing for the prothrombin time international normalized ratio (n = 47) were excluded. We compared international normalized ratio values and the time interval from arrival to the report of test results (door-to-international normalized ratio time) between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio. In patients who underwent thrombolysis, we compared the time interval from arrival to thrombolysis (door-to-needle time) between the current study population and historic cohort at our center. Results: In the 155 patients included in the study, the median door-to-international normalized ratio time was 9.0 min (interquartile range, 5.0–12.0 min) for point-of-care testing for the prothrombin time international normalized ratio and 46.0 min (interquartile range, 38.0–55.0 min) for central laboratory testing for the prothrombin time international normalized ratio (p < 0.001). The intraclass correlation coefficient between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio was 0.975 (95% confidence interval: 0.966–0.982). Forty-nine of the 155 patients underwent intravenous thrombolysis. The door-to-needle time was significantly decreased after implementation of point-of-care testing for the prothrombin time international normalized ratio (median, 23.0 min; interquartile range, 16.0–29.8 vs median, 46.0 min; interquartile range, 33.5–50.5 min). Conclusion: Utilization of point-of-care testing for the prothrombin time international normalized ratio was feasible in the management of patients with acute ischemic stroke. Point-of-care testing for the prothrombin time international normalized ratio was quick and reliable and had a pivotal role in expediting thrombolysis.

European Concerted Action on Anticoagulation (ECAA): International Normalized Ratio Variability of CoaguChek and TAS Point-of-Care Testing Whole Blood Prothrombin Time Monitors

2002 ◽  
Vol 88 (12) ◽  
pp. 992-995 ◽  
Author(s):  
M. Keown ◽  
N. Chauhan ◽  
C. Shiach ◽  
A. M. H. P. van den Besselaar ◽  
A. Tripodi ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Whole Blood ◽  
Point Of Care ◽  
International Normalized Ratio ◽  
Operator Technique ◽  
Concerted Action ◽  
Point Of Care Testing ◽  
Blood Samples ◽  
International Normalised Ratio ◽  
Whole Blood Samples

SummaryThe object was to assess the variability in displayed International Normalised Ratio (INR) between monitors of the same manufacture using whole blood samples from the same subjects. Two brands of monitor, CoaguChek Mini and the TAS PT-NC were tested.14 instruments of each brand were tested on the same day at the same laboratory by the same operator using identical blood samples to avoid between-centre differences in samples and operator technique. Whole blood samples from two normal donors and four coumarintreated patients were tested to assess between-instrument variability of INR.Results have been coded. There was a much wider dispersion of INR on Brand B than on Brand A. One Brand A instrument failed to give a result with one of the two whole blood samples from one patient. One Brand B monitor gave an aberrant result with one of the samples from a normal subject.On both brands of monitor, INR variability appeared to be due mainly to duplication differences rather than between-instrument variability on both normal and coumarin whole blood samples.

Importance of Device Evaluation for Point-of-Care Prothrombin Time International Normalized Ratio Testing Programs

2005 ◽  
Vol 80 (2) ◽  
pp. 181-186 ◽  
Author(s):  
Robert D. McBane ◽  
Cindy L. Felty ◽  
Mindy L. Hartgers ◽  
Rajeev Chaudhry ◽  
Lisa K. Beyer ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Point Of Care ◽  
International Normalized Ratio

scholarly journals Clinical evaluation of whole blood prothrombin time (PT) and international normalized ratio (INR) using a Laser Speckle Rheology sensor

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Markandey M. Tripathi ◽  
Satoru Egawa ◽  
Alexandra G. Wirth ◽  
Diane M. Tshikudi ◽  
Elizabeth M. Van Cott ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Clinical Evaluation ◽  
Whole Blood ◽  
International Normalized Ratio ◽  
Laser Speckle

Thromboelastometry as an Alternative Method for Coagulation Assessment in Pediatric Patients Undergoing Invasive Procedures: A Pilot Study

2018 ◽  
Vol 29 (03) ◽  
pp. 298-301
Author(s):  
Miroslav Durila ◽  
Jakub Jonas ◽  
Marianna Durilova ◽  
Michal Rygl ◽  
Jiri Skrivan ◽  
...  
Keyword(s):  
Whole Blood ◽  
Pediatric Patients ◽  
Point Of Care ◽  
Venous Catheter ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Severe Bleeding ◽  
Invasive Procedures ◽  
Coagulation Profile ◽  
Alternative Method

Introduction Standard coagulation tests (activated partial thromboplastin time [aPTT] and prothrombin time [PT]) are used for the assessment of coagulation profile in critically ill pediatric patients undergoing invasive interventions such as insertion of central venous catheter, tonsillectomy, laparotomy, etc. However, these tests do not reflect the profile of whole blood coagulation. Rotational thromboelastometry (ROTEM) as a point of care (POC) viscoelastic test may serve as an alternative method. Due to its ability to assess coagulation profile of the whole blood, it might yield normal results despite prolonged aPTT/PT results. The aim of this study was to find out if there was any severe bleeding during or after invasive procedures if ROTEM test was normal despite prolonged values of aPTT/PT in pediatric patients. Materials and Methods We retrospectively analyzed data for the years 2015 to 2017 for pediatric patients with prolonged values of aPTT or PT and normal ROTEM tests—internal thromboelastometry (INTEM) (assessing internal pathway of coagulation) and external thromboelastometry (EXTEM) (assessing external pathway of coagulation)—and we looked for severe bleeding during or after invasive procedures. Results In 26 pediatric patients (children from 2 months to 17 years old), we found that INTEM and EXTEM tests showed normal coagulation despite prolonged values of aPTT ratio with a median of 1.47 (minimum 1.04 and maximum 2.05), international normalized ratio with a median of 1.4 (minimum 0.99 and maximum 2.10), and PT ratio with a median of 1.30 (minimum 0.89 and maximum 2.11). In these patients, no severe bleeding was observed during interventions or postoperatively. Conclusion Our data support using thromboelastometry method as an alternative coagulation test for the assessment of coagulation profile in pediatric patients undergoing surgical or other invasive procedures, especially using it as a POC test. All invasive procedures in our study were performed without severe bleeding despite prolonged values of PT/aPTT with normal ROTEM results. It seems that ROTEM assessment of coagulation may lead to decreased administration of fresh frozen plasma and shorten time of patient preparation for intervention.

Monitoring of Coagulation during Hemorrhagic Surgery by Central Laboratory and Near-Patient Testing. Results of a Multicenter Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1043-1043
Author(s):  
Pierre A. Toulon ◽  
Yves Ozier ◽  
Annick Ankri ◽  
Marie-Helene Fleron ◽  
Genevieve Leroux ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Whole Blood ◽  
Capillary Tube ◽  
Point Of Care ◽  
Trauma Surgery ◽  
Control Sample ◽  
Fresh Frozen Plasma ◽  
Central Laboratory ◽  
Blood Samples ◽  
Arterial Blood

Abstract One of the critical issues in the monitoring of coagulation during surgery is the delay required to obtain results when tests are performed in a central laboratory. The CoaguChek ProDM (Roche Diagnostics) is a point-of-care (POC) coagulation analyzer designed to perform the measurement of clotting times such as the prothrombin time (PT) or the INR, and the activated partial thromboplastin time (APTT). So far, it has been mainly evaluated in the control of anticoagulation in patients on warfarin. A 45 μl-whole blood sample is disposed in the well of a specific 37°C-prewarmed single-use cartridge. It then circulates in a capillary tube coated with a specific agent. The test result is usually obtained in less than 5 min. The precision, evaluated as the “within-run” coefficient of variation (n=7), was found in the range from 3.2% to 7.3% depending of both the lyophilized whole blood control sample evaluated (normal or abnormal) and the clotting time performed. The aim of this multicenter study was to evaluate the performance of the CoaguChek ProDM in the monitoring of coagulation (PT and APTT) during hemorrhagic surgery. For that purpose, 78 patients undergoing surgical procedure (liver transplantation, liver resection, vascular and orthopedic/trauma surgery) were included in 3 centers after the study was approved by our Ethic Committee. Arterial blood samples were drawn at least 2 times: before the surgical incision and after a blood loss of 25% or more. Blood samples were simultaneously sent to the central laboratory and analyzed using the POC device. A total of 171 consecutive paired analyses were conducted. There was a very good agreement of the point-of-care-based monitoring of PT (sec) with the central laboratory monitoring (r=0.92, p&lt;0.0001). However, the results were not identical, with significantly shorter clotting times (and lower ratios) obtained on the CoaguChek. It could be mentioned that, the difference was dramatically reduced when PT was expressed as the percentage, as it is usual in France. Comparison was less conclusive for APTT (r=0.82), with shorter clotting times (and lower ratios) again on the CoaguChek. Moreover, APTT measurement was found to be of limited interest in the studied population, particularly in the case of infusion of aprotinin which leaded to highly prolonged APTT (above the detection limits defined for the POC analyzer and for the central laboratory instrument, a STA analyzer). These results suggest that the CoaguChek ProDM allows an accurate measurement of PT in patients undergoing hemorrhagic surgical procedures. However, the results were not identical to that obtained from the central laboratory, suggesting that the transfusion algorithms would have to be adapted accordingly. One of the main advantages gained using POC testing is the ability to obtain results more rapidly. Actually, the turn-around time, defined as the elapsed time from blood sampling until availability of the results for the clinicians, was highly significantly shorter for the POC system than for the central laboratory (below 5 min vs. 60 min median value, range: 40-&gt;120 min). Finally, the clinical interest of such a point-of-care monitoring of coagulation deserves to be prospectively investigated, especially in connection with the amount of transfused fresh frozen plasma units.

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