Measuring International Normalized Ratios in Long-Term Care: A Comparison of Commercial Laboratory and Point-of-Care Device Results

Bluestein, Daniel; Brantley, Cynthia; Barnes-Eley, Myra; Gravenstein, Stefan; Basta, Sameh A

doi:10.1016/j.jamda.2007.02.006

Cited by 11 publications

(2 citation statements)

References 18 publications

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“…Warfarin therapeutics have preventable adverse results such as bleeding from over anticoagulation and thrombotic issues resulting from insufficient treatment [1]. Routine monitoring of the prothrombin time is fundamental to minimize the risk of both bleeding and thromboembolic events.…”

Section: Introductionmentioning

confidence: 99%

The Success of Self-Testing for Anticoagulation Therapy

Songur¹

2014

Ann Clin Anal Med

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ÖzetAmaç: Varfarin tedavisinin optimum olabilmesi için gerekli olan terapötik INR (International normalized ratio) aralığı oldukça dardır. Sık kontrol gerektiren doz ayarının yapılabilmesi için çok çeşitli yöntemler mevcuttur. Bu çalışma-nın amacı; kişisel ölçüm cihazlarının doz ayarlanmasının yapılmasında ne kadar güvenli olduğunun tespit edilmesidir. Gereç ve Yöntem: Herhangi bir sebeple varfarin tedavisi alan 46 hasta çalışmaya dahil edildi. Hastaların yaşla-rı 24-84 aralığında değişmekte idi. 26 hasta erkek, 20 hasta ise kadındı. Hastalar laboratuvar INR sonuçlarına göre 3 gruba ayrıldılar. Grup 1: INR değeri 2,0'ın altında olan, grup 2: INR değeri 2,0-3,5 , grup 3: INR değeri 3,5 ve üze-rinde olan hastalardan oluşturuldu. Her üç grupta sırasıyla 15, 16, 15 hasta vardı. Hastalara parmak ucu kanından kişisel ölçüm cihazı ile INR kontrolü yapıldı. INR sonuçlarının etkileneceği etmenler göz önünde bulundurularak, üç grupta ortalama yaş, cinsiyet, hematokrit değeri, trombosit sayısı, kullanılan ilaçlar açısından istatistiksel anlamlı bir farklılık yoktu. Bulgular: Birinci grubun laboratuvar ölçümlerinde INR ortalaması 1.26 iken kişisel ölçüm cihazın-da ölçülen ortalama INR değeri 1.45 olarak tespit edildi ve her iki grup arasın-da istatistiksel anlamlı bir fark bulunamadı (p=0.15). İkinci grubun laboratuvar ölçümlerinde tespit edilen INR ortalama INR değeri 2.74 iken cihazda tespit edilen ortalama INR değeri 3.51 olarak tespit edildi (p=0.01). Üçüncü grubun laboratuvar cihazıyla tespit edilen ortalama INR değeri 4.27 iken cihazda tespit edilen ortalama değer 5.25 olarak tespit edildi (p=0.01). Tartışma: Varfarin tedavisinin sebep olacağı hemorajik ve tromboembolik komplikasyonların önlenmesi açısından, INR doz ayarlanmasının düzenli aralıklarla, uzman kişiler tarafından ve hastanelerde yapılmasının uygun olacağını savunuyoruz. Grup 1 had INR results lower than 2, group 2 had INR levels of 2 to 3.5, group 3 had INR levels of higher than 3.5 INR of the patients were remeasured with the POC device. Results: The ages of the patients were between 24 to 84. Twenty six patients were male and 20 were female. The mean INR level of laboratory measurements was 1.26 in group 1 whereas it was 1.45 for POC device measurements. There were not statistically significant difference between two devices for group 1 (p=0.15). In group 2 the mean INR levels were measured by laboratory instrument and POC device were 2.74 and 3.51 respectively (p=0,01). In group 3 mean INR levels were measured by laboratory instrument and POC device were 4.27 and 5.25 respectively (p=0.01). Anahtar KelimelerDiscussion: We suppose it is rational to adjust warfarin dosage by specialists using laboratory results in order to prevent hemorrhagic and thromboembolic complications.

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Section: Introductionmentioning

confidence: 99%

The Success of Self-Testing for Anticoagulation Therapy

Songur¹

2014

Ann Clin Anal Med

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“…The use of the INR (International Normalised Ratio) as a standard measure for reporting the results of blood coagulation tests permitted the development of effective recommendations for monitoring pa-tient OAT (5,6). With these concerns in mind, the development of small and portable point-of-care medical (POC) devices and computer-assisted technologies have led to new strategies for patient OAT self-monitoring and self-adjustment of the dose (7)(8)(9)(10)(11)(12)(13). A number of clinical trials and pharmaco-economic studies indicate that self-management of INR can be feasible, safe, cost effective and beneficial in maintaining therapeutic anticoagulation (8,(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Implementation of SintromacWeb®, a new internet-based tool for oral anticoagulation therapy telecontrol: Study on system consistency and patient satisfaction

Ferrando¹,

Mira²,

Contreras³

et al. 2010

Thromb Haemost

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Most computer- or internet-assisted systems for oral anticoagulation therapy (OAT) telemanagement have limitations when it comes to implementation within a healthcare center. It was the objective of this study to evaluate convenience and patient satisfaction with the use of SintromacWeb, a new OAT telecontrol system, compared with the conventional control. SintromacWeb consists of a point-of-care device for patient international normalized ratio (INR) self-testing and software that allows internet mediated interaction with physicians. Patients initiated the use of SintromacWeb and were followed up during a three-month period. A score-based questionnaire was completed in three controlled visits, and data were subsequently analysed. A total of 102 patients were enrolled. At first visit, 55.7% of the patients had their INR within normal range, and 64.9% at the final visit. Internal consistency of the questionnaire was good (Cronbach's a: 0.79). Scores in the questionnaire were independent of patient's age, education level, working status and INR value. The most valued features of SintromacWeb were: fewer visits to the hospital, simplicity and convenience of the system, and time administration for control tasks (86.7%, 82.7% and 77.6% of very satisfied patients, respectively). Also, patients showed indifference or were dissatisfied with the conventional system. At the final visit, 99% of patients declared that they were satisfied with their OAT control. Moreover, all patients continued using SintromacWeb after completion of the study. In conclusion, SintromacWeb telecontrol is a new model for management of anticoagulated patients. It was highly accepted and can be used by all patients regardless of their sociodemographic characteristics.

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Dispositivos de coagulometría portátil en el seguimiento y control ambulatorio de la terapia anticoagulante oral: revisión sistemática

2011

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The analytical-validity related articles show that portable coagulometers have an equivalent effectiveness to conventional coagulometers. Studies that include patient-reported outcomes show that self-monitoring patients, by means of portable coagulometers, have better analytical measurement results and fewer rates of thromboembolic events. Survival was analysed in very few studies; nevertheless, all of these show lower mortality. Similarly, the minority of selected articles includes economic evaluations, although they suggest a better cost-effectiveness of portable coagulometers compared to the conventional mode.

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Measuring International Normalized Ratios in Long-Term Care: A Comparison of Commercial Laboratory and Point-of-Care Device Results

Cited by 11 publications

References 18 publications

The Success of Self-Testing for Anticoagulation Therapy

The Success of Self-Testing for Anticoagulation Therapy

Implementation of SintromacWeb®, a new internet-based tool for oral anticoagulation therapy telecontrol: Study on system consistency and patient satisfaction

Dispositivos de coagulometría portátil en el seguimiento y control ambulatorio de la terapia anticoagulante oral: revisión sistemática

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