An audit of coagulation screening in patients presenting to the emergency department for potential stroke thrombolysis

Thorne, Katie; McNaughton, Harry; Weatherall, Mark

doi:10.1111/imj.13323

Cited by 6 publications

(11 citation statements)

References 5 publications

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“…Analyses revealed that in other settings, the processing time of laboratory samples for INR measurements in stroke patients was too long [ 26 ]: The German Guideline “Acute therapy of ischemic stroke “and its 2015 addendum refers to Rizos et al, who state that POCT-INR measurements are sufficiently precise and reduce time intervals until thrombolysis [ 6 , 27 ]. The aim of our study was, inter alia, to provide sufficient data under actual conditions regarding legal updates (current RiliBAEK version) and analyze values exceeding the critical INR cut-off to help clinicians to decide whether it is useful to opt for INR values with standard laboratory procedure.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis in stroke patients: Comparability of point-of-care versus central laboratory international normalized ratio

et al. 2018

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BackgroundIn acute stroke patients, thrombolysis is one gold standard therapy option within the first four hours after the ischemic event. A contraindication for thrombolysis is an International Normalized Ratio (INR) value >1.7. Since time is brain, rapid and reliable INR results are fundamental. Aim was to compare INR values determined by central laboratory (CL) analyzer and Point-of-Care Testing(POCT)-device and to evaluate the quality of POCT performance in cases of potential therapeutic thrombolysis at a certified stroke unit.MethodsIn 153 patients INR measurements using POCT-devices (HEMOCHRON Signature Elite®) were compared to INR measurements (BCS®XP) performed at the central laboratory. Outlier evaluation was performed regarding the critical thrombolysis cut-off.ResultsOverall, we demonstrated a significant correlation (r = 0.809, p<0.0001) between both measurement methods. Mean value of the absolute difference between CL-INR and POCT-INR measurements was 0.23. In 95.4% of these cases, no differences regarding the critical cut-off (INR 1.7) were observed. POCT-INR values tended to be higher than the CL-INR values (p = 0.01). In 4.6% cases, a different value regarding thrombolysis cut-off was found. All patients were >75 years.ConclusionsPOCT-INR measurements based on our POCT concept are suitable to determine INR values in critical stroke patients. Nevertheless, outlier evaluation is mandatory.

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Section: Discussionmentioning

confidence: 99%

Thrombolysis in stroke patients: Comparability of point-of-care versus central laboratory international normalized ratio

et al. 2018

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“…Current clinical guidelines recommend that thrombolytic therapy not be delayed by coagulation and haematological testing unless there is clinical suspicion of bleeding, thrombocytopenia or anticoagulant use, with potential issues arising from misdiagnosis and neglecting contraindications 13,81 . Current literature supports the use of POCT coagulation studies, which can be completed in under a minute, in expediting workflow by up to 63 minutes with similar safety profiles to laboratory tests 82‐84 Similarly, blood‐count, blood‐chemistry and stroke biomarker POCTs may be administered within minutes in order to streamline diagnosis, treatment and evaluation of stroke subtype, severity and prognosis 81,85,86 . A cumulative point‐of‐care workflow system was effective in reducing time to therapy by 44 minutes; however, delayed central laboratory times, small sample size and exclusion of haemorrhagic‐stroke patients may have overestimated the intervention effect 87 .…”

Section: In‐hospital Workflow Parametersmentioning

confidence: 99%

In‐hospital acute stroke workflow in acute stroke – Systems‐based approaches

et al. 2020

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The therapeutic goal for acute ischaemic stroke (AIS) patients is to achieve timely restoration of cerebral blood flow to the ischaemic brain tissue at risk of infarction and reduce neurological complications. 1 Current literature supports the efficacy and use of intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) in the treatment of AIS, with EVT proven to be more efficacious in patients presenting with large vessel occlusion (LVO). 2-5 When tPA and EVT are administered within their therapeutic time window of ≤4.5 and ≤6 hours, respectively, both therapies improve both recovery and clinical outcome of stroke patients. 2-6 Results from the DAWN trial have proposed extending the therapeutic time window for EVT to 24 hours due to improved efficacy and similar safety profiles. 7 Time to treatment is arguably the most important determinant of the efficacy of reperfusion

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“…The POCT can be directly connected using Bluetooth or USB to send the test results to a healthcare professional quickly and with ease [100]. The INR POCT results correlates well with laboratory values and can be used to shorten door-to-needle time [98,101,102].…”

Section: Coaguchek® (Roche)mentioning

confidence: 99%

Rapid Point-of-Care-Tests for Stroke Monitoring

2019

Organic Bioelectronics for Life Science and Healthcare

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Stroke contributes to at least 7 million deaths annually and is the second leading cause of death globally. Ischemic stroke is the most common type of stroke where an interruption of blood flow within brain tissues can lead to cessation of brain activities. Central to existing reperfusion treatment strategies is prompt restoration of blood supply to compromised brain tissues. Existing methods of monitoring the progress of stroke evolution are limited to clinical evaluation and neuroimaging techniques. With advances in biomarker research, there is now a growing interest in the use of stroke biomarkers to guide clinical decision-making, especially for on-site biomarker measurements, to make time-sensitive decisions on stroke prognosis. This chapter presents an overview on pointof-care-tests (POCT) used to guide stroke prognosis, with the aim of shortening time-totreatment, classifying stroke subtypes and improving patient's outcome. First, the current stroke monitoring workflow is presented, which highlights gaps for an improved bedside biomarker assessment. Second, a detailed overview on the different POCTs used for

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An audit of coagulation screening in patients presenting to the emergency department for potential stroke thrombolysis

Cited by 6 publications

References 5 publications

Thrombolysis in stroke patients: Comparability of point-of-care versus central laboratory international normalized ratio

Thrombolysis in stroke patients: Comparability of point-of-care versus central laboratory international normalized ratio

In‐hospital acute stroke workflow in acute stroke – Systems‐based approaches

Rapid Point-of-Care-Tests for Stroke Monitoring

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