Purpose To investigate the reliability of a point-of-care device, the HEMOCHRON Ò Jr. Signature, for measuring the international normalized ratio (INR) during the three surgical phases of liver transplantation. Methods A retrospective review was performed on patients undergoing liver transplantation during July to December 2013. Thirty-one patients who had simultaneous laboratory and point-of-care INR readings from each phase of liver transplant surgery (paleohepatic, anhepatic, and neohepatic) were eligible for inclusion. Bland-Altman analysis, Spearman's rank correlation, and four quadrant plots were used to compare INR results from the point-ofcare device (pocINR) with those from the laboratory (labINR). Results Based on the Bland-Altman analysis, mean biases (95% prediction interval) were 0.10 (0.03 to 0.17), 0.19 (0.12 to 0.27), and 0.21 (0.01 to 0.43) for the paleohepatic, anhepatic, and neohepatic phases, respectively. The pocINR device showed a systematic underestimation of the labINR. The Spearman's rank correlation coefficients (95% confidence interval [CI]) were: Q = 0.90 (95% CI 0.80 to 0.95); Q = 0.92 (95% CI 0.71 to 0.93); and Q = 0.71 (95% CI 0.46 to 0.85), respectively. Direction-of-change analysis between the paleohepatic to anhepatic and the anhepatic to neohepatic phases showed strong concordance of 84% and, also considering the small bias between the measurements, supports the use of the pocINR device in the clinical management of liver transplant surgery. Conclusion Point-of-care INR was accurate prior to hepatic reperfusion, but reliability decreased in the neohepatic phase. RésuméObjectif É tudier la fiabilité d'un dispositif au chevet, l'HEMOCHRON Ò Jr. Signature, pour la mesure du rapport international normalisé (RIN) pendant les trois phases chirurgicales d'une transplantation hépatique. Méthodes : Une analyse rétrospective a été menée sur des patients ayant subi une transplantation hépatique entre juillet et décembre 2013. Trente et un patients ayant des
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