Is point-of-care accurate for indicating thrombolysis in anticoagulated patients on oral anticoagulation treatments?

Bruch, Tatiana Pizzolotto; Mendes, Danielle; Pedrozo, Jeff C.; Figueiredo, Lívia; Nóvak, Edison Matos; Zétola, Viviane Flumignan; Lange, Marcos Christiano

doi:10.1590/0004-282x20140075

Cited by 6 publications

(8 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In particular, the AHA/ASO guidelines [67] recommend that, the administration of rtPA can be initiated before results of coagulation tests or platelet counts are available, unless a bleeding is observed after the patient had already received heparin or other anticoagulants. However, if rtPA protocol has been initiated and the results of the coagulation tests or platelet counts indicate that INR > 1.7 or a PT > 15 s by local protocol of rtPA administration, then the procedure should be stopped [68]. This might have contributed to the exclusion of more patients in the non telestroke in our current study.…”

Section: Discussionmentioning

confidence: 99%

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

et al. 2018

View full text Add to dashboard Cite

BackgroundIn acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients.MethodsStructured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model.ResultsThe non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025–1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16–3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961–0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032–0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223–0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046–0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322–12.611, P = 0.014).ConclusionThe direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

et al. 2018

View full text Add to dashboard Cite

show abstract

“…[ 16 ] However, to avoid hemorrhagic complications related to rtPA, confirmation of INR level ≤ 1.7 should be done in patients already taking vitamin K antagonists, which inevitably results in a time delay to thrombolytic administration. Though utilization of point of care (POC) testing could be an alternative method of reducing the waiting time for an INR report with acceptable validity, [ 17 ] universal access to such information still has a long way to go. A precise but simple way of predicting subtherapeutic INR with clinical variables is therefore worthy of investigation.…”

Section: Discussionmentioning

confidence: 99%

Major vessel occlusion may predict subtherapeutic anticoagulation intensity and feasibility of administration of intravenous thrombolytics

et al. 2017

View full text Add to dashboard Cite

ObjectiveWe investigated the association between the presence of major vessel occlusion (MVO) and the intensity of the International Normalized Ratio (INR) in cardioembolic high-risk patients taking warfarin. We also evaluated whether the presence of MVO could predict the subtherapeutic range of INR ≤1.7 ensuring safe administration of intravenous thrombolytics.MethodsThe medical records of 177 cardioembolic stroke patients who were taking warfarin between April, 2008 and March, 2015 were retrospectively analyzed. Logistic regression analysis was performed to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between vessel occlusion and intensity of INR. To predict INR ≤1.7, decision tree analysis was performed.ResultsINR was inversely associated with MVO in an unadjusted model (OR, 0.36; 95% CI, 0.17–0.76), and in a model adjusted for initial NIHSS score and time from symptom onset to arrival (OR, 0.28; 95% CI, 0.11–0.73). Fifty-two of 58 (89.7%) patients with MVO had an INR ≤1.7, compared with 83 of 119 (69.7%) patients without MVO. Indication for anticoagulation agent use was dichotomized into NVAF and others, and applied to the subgroup of patients with MVO. All patients with NVAF (31/31, 100%) had INR ≤1.7, while 21 of 27 of the other patients (77.8%) had INR ≤1.7.ConclusionsLow INR at presentation in cardioembolic stroke patients during anticoagulation treatment was associated with occurrence of major vessel occlusive stroke. Presence of MVO and indications for anticoagulation may be utilized to ensure the feasibility of administration of intravenous thrombolytics.

show abstract

“…Most of the patients had cardioembolic strokes, metallic prosthetic valves, or cerebral venous thrombosis 1 . The authors evaluated the accuracy of POC measurements to detect INR measurements lower or equal than 1.7.…”

mentioning

confidence: 99%

“…According to these guidelines, an INR .1.7 or a prothrombin time .15 seconds are exclusion criteria for intravenous thrombolysis within 3 hours from symptom onset. Also, according to AHA/ASO guidelines, taking an anticoagulant regardless of INR is a relative exclusion criterion within the time window of 3-4.5 hours from symptom onset 1 . The European rtPA license does not allow intravenous rtPA treatment for patients in use of oral anticoagulants 3 .…”

mentioning

confidence: 99%

“…Because it is known that "time is brain" in acute stroke, the AHA/ASO guidelines recommend that, in patients known not to be taking oral anticoagulants, intravenous thrombolysis can be initiated before results of coagulation tests or platelet counts are available, unless a bleeding abnormality or thrombocytopenia is suspected, the patient has received heparin or other anticoagulants. If thrombolysis is started and then results of these tests shown an INR .1.7 or a PT .15 seconds by local laboratory standard, the procedure should be discontinued 1 . The question posed by the authors is: can POC coagulometers substitute PSA and speed decision-making in the acute setting, for patients taking anticoagulants?…”

mentioning

confidence: 99%

See 1 more Smart Citation

Potential impact of point-of-care INR testing on intravenous thrombolysis

Conforto

2014

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Is point-of-care accurate for indicating thrombolysis in anticoagulated patients on oral anticoagulation treatments?

Cited by 6 publications

References 9 publications

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

Major vessel occlusion may predict subtherapeutic anticoagulation intensity and feasibility of administration of intravenous thrombolytics

Potential impact of point-of-care INR testing on intravenous thrombolysis

Contact Info

Product

Resources

About