Clinical Impact of Point-of-Care vs Laboratory Measurement of Anticoagulation

Sunderji, Rubina; Gin, Kenneth; Shalansky, Karen F.; Carter, Cedric; Chambers, Keith; Davies, Cheryl; Schwartz, Linda; Fung, Anthony

doi:10.1309/p2y3-vm4a-xpvu-daw3

Cited by 11 publications

(12 citation statements)

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“…The portability of the POCT device has facilitated INR testing that may be performed in various settings including nursing homes, at the patient’s bedside, and in ambulatory care clinics. Although various recent studies have addressed the accuracy of these devices compared to traditional laboratory testing, there has been no published data available evaluating both humanistic and clinical outcomes in pharmacist-managed clinics 1-7. At the Medical University of South Carolina (MUSC), there are three pharmacist-managed anticoagulation clinics where POCT device is utilized.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

Thompson

Ragucci

Fermo³

et al. 2009

Pharmacy Practice (Internet)

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Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory.Objective:To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT) device versus venipuncture within ambulatory care clinics at our institution.Methods:All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC) Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED) visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis.Results:A total of 145 patients were included in the data collection from the two clinics. The majority (41%) of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 %) of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post-implementation of POCT device.Conclusion:The results of this study demonstrate improvement in patient satisfaction with POCT compared to venipuncture, with limited value in clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

Thompson

Ragucci

Fermo³

et al. 2009

Pharmacy Practice (Internet)

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“…For example, Pierce et al. (2000) and Sunderji et al. (2005) both noted such differences when their results with the ProTime Microcoagulation System were compared to similar studies.…”

Section: Discussionmentioning

confidence: 90%

Quality assurance for point‐of‐care testing of oral anticoagulation: a large‐scale evaluation of the Hemochron Junior Signature Microcoagulation System

Maddox

Bogo

McGregor

et al. 2009

Int J Lab Hematology

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We report the first large-scale evaluation of the Hemochron Junior Signature (HJS) Microcoagulation System for community monitoring of oral anticoagulation and establishment of a programme of internal and external quality assurance. Over 1600 HJS results, with a simultaneous venous sample for central analysis, were obtained over a 19 month period. Monitoring of an initial period of HJS results (n = 135) revealed an International Normalized Ratio (INR) over estimation (mean +1.05), with only 27% of results within 0.5 of the central laboratory INR. A correction factor was introduced which reduced the INR bias to +0.07 and improved the percentage of results within 0.5 of the central laboratory INR to 76% (n = 353). A revised correction factor was later introduced to adjust for an under estimation at higher INR values. This changed the INR bias to -0.05, with 76% of results within 0.5 of the central laboratory INR (n = 1174). Local external quality assurance samples were distributed monthly with a total of 791 samples during the study period. 84% of test results were within 15% of the median value (range 73-97% per month). These results emphasize the value of a robust quality assurance programme when using point-of-care devices for community monitoring of oral anticoagulation.

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“…There are number of reports of evaluation of PT/INR meters [5][6][7] and their comparability with laboratory measurements. The earlier meters showed a positive bias at high INR values [8,9].…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of Point Of Care coagulation monitoring by coaguchek XS-comparison with standard laboratory method

Kumar

2010

Indian J Thorac Cardiovasc Surg

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Background Point Of Care (POC) meters are a relatively less invasive and rapid method for monitoring of Prothrombin Time/Interational Normalized Ratio (PT/INR) in patients on anticoagulant therapy. The reliability of results obtained with meters, however, needs to be affirmed and their accuracy needs to be assessed by comparing with standard laboratory analysis. We assessed the Coaguchek XS (Roche) PT/INR meter for accuracy and reliability by comparing with the results obtained with standard laboratory analysis on Stago Coagulometer. Methods INR values of 42 patients were measured by standard laboratory method using thromboplastin, Neoplastin CI (Diagnostical Stago, France) with ISI of 1.7 on Coagulometer (Stago) in plasma. Simultaneously a drop of blood was taken on the strip for Coagulochek XS and the INR read by the meter. Correlation between INR values obtained by the two methods was assessed by computing the correlation coefficient and the intra class correlation coefficient. Agreement between the INR values was assessed by Bland Altman plots. Results An excellent correlation was observed between INR values obtained by coaguchek XS and the values obtained in the laboratory by standard method for a range of values. Bland Altman plots showed good agreement between values obtained by the two methods with only three values falling beyond 2SD limits. Conclusion In conclusion Coaguchek XS INR meters are reliable and accurate and can be used by patients for monitoring of anticoagulation therapy.

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Clinical Impact of Point-of-Care vs Laboratory Measurement of Anticoagulation

Cited by 11 publications

References 0 publications

Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

Quality assurance for point‐of‐care testing of oral anticoagulation: a large‐scale evaluation of the Hemochron Junior Signature Microcoagulation System

Comparative evaluation of Point Of Care coagulation monitoring by coaguchek XS-comparison with standard laboratory method

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