Reliability of Point-of-Care International Normalized Ratio Testing in an Academic Family Medicine Clinic

Emily J. Christenberry, Margie E. Padilla, M. Aguirre, Amanda Loya, Lorenzo Aragón
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Abstract

Abstract A recent increase in the number of point-of-care (POC) international normalized ratio (INR) measurements greater than 4 and the need for venous confirmatory testing in an academic family medicine clinic has led to the further exploration of the accuracy of POC INRs greater than 4. The primary objective of this quality improvement project was to compare the POC INR measurements with confirmatory venipuncture INR measurements. Seventeen patients representing 41 separate encounters over a 20-month period were retrospectively reviewed. The median POC INR was 4.5 (interquartile range, 4.1 to 5.1) versus a median venous INR of 3.4 (interquartile range, 3 to 3.9) of the 27 patient encounters where a venous INR was available. This difference between POC and venous INR resulted in a change in therapy for over 80% of the patients, which is a higher-than-reported discrepancy between POC INRs and venous INRs in patients with a POC INR greater than 4. Clinicians using the results of these POC devices who are unaware of the potential positive bias in POC INR values compared with venous draw values are at risk for making warfarin dose reductions, which can put their patients at risk for thromboembolic events.
某学术性家庭医学诊所护理点国际标准化比值检测的可靠性
近年来,随着医疗点(POC)国际标准化比值(INR)测量值大于4的数量的增加,以及学术家庭医学诊所对静脉确认试验的需求,导致了POC INR大于4的准确性的进一步探索。该质量改进项目的主要目的是比较POC INR测量值与确认性静脉穿刺INR测量值。在20个月的时间里,我们对17名患者进行了回顾性研究。在27例可获得静脉INR的患者中,POC INR中位数为4.5(四分位数范围4.1至5.1),而静脉INR中位数为3.4(四分位数范围3至3.9)。POC和静脉INR之间的差异导致超过80%的患者改变了治疗方法,这比POC INR大于4的患者的POC INR和静脉INR之间的差异要高。使用这些POC装置结果的临床医生如果没有意识到POC INR值与静脉抽吸值相比存在潜在的正偏倚,则有减少华法林剂量的风险,这可能使患者面临血栓栓塞事件的风险。
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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