Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Kasinathan, Ganesh; Pairan, Shakirin; Rowther, Sirajudeen; Sulaiman, Sharifah; Basimin, Siti A.; Samsuni, Norazema; Balasegar, Vidhubala

doi:10.4236/oalib.1102428

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…Similarly, in the present study, POCT intervention was found to reduce the overall waiting time markedly from 180 minutes to less than 30 minutes. These findings also resonate with the findings of Kasinathan et al [6] On comparing and correlating the results of POCT (with a handheld device) and core laboratory analyzer, an overall good agreement between POCT and laboratory plasma INR results using CLSI 14-A agreement limits and ISO 17593-2007 acceptability criteria of allowable difference within 90% of all results was achieved; this makes the Hemochron POCT device adequate for clinical use. Although ISO 17593-2007 criteria do not pertain to in vitro measuring systems assessing vitamin K antagonist (warfarin) therapy at a health care facility, we applied it to guide individuals who could use such handheld devices to perform INR self-testing for monitoring and or managing their own warfarin therapy.…”

Section: Discussionsupporting

confidence: 86%

Efficacy of Point-of-Care for INR Testing Compared to Standard Laboratory Methods at a Tertiary Care Hospital in Saudi Arabia

Bhat

Abuzied

Fagih

et al. 2020

Global Journal on Quality and Safety in Healthcare

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Introduction Regular testing of the international normalized ratio (INR) is essential for people taking vitamin K antagonists as part of anticoagulation therapy. This study was undertaken to ascertain the efficacy of point-of-care testing (POCT)-INR versus conventional core laboratory testing in terms of result adequacy, waiting-time reduction, and patient satisfaction enhancement at the thrombosis clinic of the outpatient Medical Specialties Department in King Fahad Medical City, Saudi Arabia. Methods The study was conducted prospectively for 6 months (from June 2017 to December 2017) on 182 eligible participants out of 250 entitled patients who were attending the thrombosis clinic for warfarin dose adjustment and who fulfilled all the prerequisites for performing dual testing by fingerstick at the clinic and venipuncture by the core laboratory. The data-capturing template created on Microsoft Excel recorded turnaround times (TATs), clinical concordance of INR result variables by POCT, and laboratory methods. Individual patient experience was recorded to gauge satisfaction rate, and all the data were analyzed statistically. Results Of 182 patients included in the study, overall good concord was observed between POCT whole blood and laboratory plasma INR results with median bias of 0.07 and 92.3% agreement using acceptability criteria for clinical concordance of Clinical Laboratory Standards Institute (CLSI) 14-A and International Standards Organization (ISO) 17593-2007, respectively. Marked improvement in terms of patient's time spent at the clinic was noted, with substantial reduction from 180 to ∼30 minutes (p < 0.001). Survey questionnaire responses indicated that POCT of INR was highly convenient and enhanced patient experience in terms of shorter wait time, minimal invasive procedures, and immediate result availability (p < 0.001). Predominantly, participants (75.4%) endorsed and expressed a strong preference for the POCT procedure over conventional laboratory testing. Conclusions Whole blood INR testing for warfarin dose adjustment with validated POCT devices is adequately comparable to the core laboratory results. It also simplifies workflow steps at the thrombosis clinic, enhancing patient experience and convenience via the immediate availability of results, a less invasive procedure, and a marked reduction in waiting time. However, caution is needed with regard to higher INR results (≥4.7), which call for core laboratory confirmation.

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Section: Discussionsupporting

confidence: 86%

Efficacy of Point-of-Care for INR Testing Compared to Standard Laboratory Methods at a Tertiary Care Hospital in Saudi Arabia

Bhat

Abuzied

Fagih

et al. 2020

Global Journal on Quality and Safety in Healthcare

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“…10 Consequently, INR monitoring can improve its stability within the therapeutic range and prevent serious complications. 11 Based on the background described above, an evaluation of warfarin use in heart disease patients at Dr. Hasan Sadikin Hospital was conducted to determine the drug use profile, effectiveness, and if the administered therapy dose has reached the target therapeutic INR value of 2 to 3. Dispensation of safe and effective warfarin doses improves the therapy's success and patient's life quality and avoids side effects of bleeding.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Warfarin Use in Cardiac Clinic Outpatients

Putriana¹,

Rusdiana

Rostinawati

et al. 2022

Pharmacology and Clinical Pharmacy Research (PCPR) is an intern

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The use of warfarin was monitored using the International Normalized Ratio (INR) value. This study aims to determine the relationship between the patient’s demographic variables and INR, as well as the therapy result and differences in their INR value. A cross-sectional study was used with retrospective observational data collected by tracing secondary information of medical records from outpatients with heart disease on warfarin therapy at Dr. Hasan Sadikin hospital Bandung between 2016 to 2020. Subsequently, the difference in patients’ INR value was analyzed with the Mann-Whitney test based on dosage. At the same time, the relationship between demographic variables and INR was examined using the Chi-square test and Spearman correlation. The INR examination results in 192 subjects showed 124 patients (64.6%) reached the target with an average value of 2.37 ± 0.21 and a warfarin dose of 19.31 ± 6.25 mg weekly, while 68 (35.4%) had an average of 1.82 ± 0.73 and a dose of 20.24 ± 6.24 mg weekly. Subsequently, the difference test with Mann Whitney (p = 0.004) showed a variation in the INR value based on the warfarin dose. The Spearman correlation analysis results indicated a relationship between BMI (p = 0.009), daily (0.010), and weekly dose (0.008) on the INR value with the correlation coefficient of 0.188; 0.186; and 0.192; indicating a negative association with very weak correlation strength. This study showed that a majority of patients reached the INR value of 2-3, and the demographic variables associated with this ratio were BMI and warfarin dose. The decision to increase and decrease the warfarin dose is determined by INR value and BMI.

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“…During the development of research on major bleeding related to warfarin, the mortality rate reached 9.5-13.4% [7,8]. An examination of the international normalized ratio (INR) in patients receiving warfarin therapy is needed to monitor the chances of bleeding [9,10].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Warfarin Oral Used by International Normalized Ratio Value and Determination Frequency to Cardiovascular Patient at Haji Adam Malik General Hospital, Medan, Indonesia

Pertiwi

Suwarso

Manik

2018

Asian J Pharm Clin Res

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Objective: The objective of this research was to evaluate of warfarin oral used by value and determination frequency of international normalized ratio (INR).Methods: The data of cardiovascular patients were collected from medical records in Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia, in 2016. This study evaluated the data by retrospective study design. The sample study was selected by Slovin method from the population of medical record of cardiovascular patients who received warfarin therapy. The sample of population was divided based on how many times the INR was measured. The groups are no measurement, once a year, unregularly schedule, thrice a year, and every month. The data were analyzed by analysis of variant to evaluated association of INR values and groups of patients.Result: The total sample in this study was 90 patients based on Slovin formula. The percentage of patient who never gets INR checked was 18.89%, once a year was 32.2%, unregularly was 34.44%, thrice a year was 8.89%, and every month was 5.56%. The value of INR in groups was 0.00 ± 0.00 in never checked group, once in year was 1.18 ± 0.44, unregularly was 1.79 ± 1.00, once time in 3 months was 2.04 ± 0.73, and every month was 2.42 ± 0.91. The groups of patients with never evaluation of INR value were significantly different with the other groups (p≤0.05).Conclusion: The results obtained in this study indicated the majority patients group in case of warfarin oral used and evaluation of bleeding status were once checked in year and unregularly determination of INR value. The best condition, in this case, was the determination of INR value in every month caused the bleeding or coagulation status of patient can be evaluated.

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Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Abstract: G. Kasinathan et al.OALibJ |

Cited by 3 publications

References 11 publications

Efficacy of Point-of-Care for INR Testing Compared to Standard Laboratory Methods at a Tertiary Care Hospital in Saudi Arabia

Efficacy of Point-of-Care for INR Testing Compared to Standard Laboratory Methods at a Tertiary Care Hospital in Saudi Arabia

Evaluation of Warfarin Use in Cardiac Clinic Outpatients

Evaluation of Warfarin Oral Used by International Normalized Ratio Value and Determination Frequency to Cardiovascular Patient at Haji Adam Malik General Hospital, Medan, Indonesia

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