Reliability of Point-of-Care International Normalized Ratio Measurements in Various Patient Populations

Kim Arline, C. Rodriguez, K. Sanchez
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引用次数: 3

Abstract

Purpose The aim of this study was to determine if the Coagsense point-of-care (POC) instrument provides more reliable international normalized ratio (INR) measurements than Coagucheck XS POC in comparison to the Stago laboratory instrument in different disease states. Methods This was a prospective study of outpatient warfarin patients comparing venous Stago INR to fingerstick INR on the Coagsense and Coagucheck XS POC meters. Patients were invited to study if they had an of INR 2.0 to 5.0 and had a medical history of antiphospholipid syndrome, hypercoagulable disorder, autoimmune condition, peripheral vascular disease, mechanical heart valve, atrial fibrillation, or deep vein thrombosis/pulmonary embolism/cerebrovascular accident history. Results Seventy-seven patients were enrolled. Coagsense correlated well (92% of INRs within 20% of Stago, 64% of INRs within 0.2 of Stago, overall INR bias of 0.1 or 4%). Six patients had greater than 20% POC INR bias, which could have resulted in 4 warfarin dosing errors. Coagucheck XS INRs correlated poorly (49% within 20% of Stago, 10% of INRs were within 0.2 of Stago, overall INR bias of 0.66 or 25.7%). Forty-one patients had greater than 20% POC INR bias in all diseases, which could have resulted in 28 warfarin dosing errors. The average Coagucheck XS INR bias (0.46–1.3 INR) increased with each 0.5 increase in laboratory INR, whereas Coagsense bias remained stable (0.1–0.25) as INR increased up to 4.3. Two patients correlated well on Coagucheck XS but not Coagsense. Conclusion Coagsense correlated better than Coagucheck XS and did not show increasing bias as INR increased. Both POC instruments had higher INR variability in 4 disease states (antiphospholipid syndrome, autoimmune, peripheral vascular disease, and hypercoagulable). Patient-specific laboratory correlations may be needed on each POC device.
在不同患者群体中护理点国际标准化比率测量的可靠性
目的本研究的目的是确定在不同疾病状态下,与Stago实验室仪器相比,凝血护理点(POC)仪器是否比Coagucheck XS POC提供更可靠的国际标准化比率(INR)测量。方法对门诊华法林患者进行前瞻性研究,比较静脉Stago INR和手指针刺INR在凝血仪和Coagucheck XS POC仪上的差异。如果患者的INR为2.0 - 5.0,并且有抗磷脂综合征、高凝障碍、自身免疫性疾病、外周血管疾病、机械心脏瓣膜、心房颤动或深静脉血栓形成/肺栓塞/脑血管意外病史,则邀请患者进行研究。结果共纳入77例患者。凝血相关良好(20% Stago内的INRs为92%,0.2 Stago内的INRs为64%,总体INR偏差为0.1或4%)。6例患者的POC INR偏差大于20%,这可能导致4个华法林剂量错误。Coagucheck XS INRs相关性较差(49%在Stago的20%范围内,10%的INRs在Stago的0.2范围内,总体INR偏差为0.66或25.7%)。41例患者在所有疾病中POC INR偏差大于20%,这可能导致28例华法林剂量错误。实验室INR每增加0.5,Coagucheck XS INR平均偏倚(0.46-1.3 INR)增加,而当INR增加到4.3时,凝固偏倚保持稳定(0.1-0.25)。两例患者的Coagucheck XS相关性良好,但凝血功能不相关。结论与Coagucheck XS的相关性较好,且不随INR的增加而增加偏倚。两种POC仪器在4种疾病状态(抗磷脂综合征、自身免疫、外周血管疾病和高凝)中都有更高的INR变异性。每个POC设备可能需要患者特定的实验室相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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