Point-of-Care International Normalized Ratio Testing Accelerates Thrombolysis in Patients With Acute Ischemic Stroke Using Oral Anticoagulants

Abstract

Background and Purpose-Thrombolysis in patients using oral anticoagulants (OAC) and in patients for whom information on OAC status is not available is frequently delayed because the standard coagulation analysis procedure in central laboratories (CL) is time-consuming. By using point-of-care (POC) coagumeters, international normalized ratio (INR) values can be measured immediately at the bedside. The accuracy and effectiveness of POC devices for emergency management in acute ischemic stroke has not been tested. Methods-In phase 1, the reliability of emergency INR POC measurements in comparison to CL was determined. In phase 2, patients with ischemic stroke admitted within the time frame for systemic thrombolysis and who were either using OAC or for whom information on OAC status was not available were enrolled. Patients received thrombolysis if POC INR was Յ1.5. Precision and time gain was recorded for INR as measured by POC vs CL. Results-In phase 1 (nϭ113), Bland-Altman analysis showed close agreement between POC and CL, and Pearson correlation was highly significant (rϭ0.98; PϽ0.01). In phase 2, 48 patients were included, of whom 70.8% were using OAC; 23 patients received thrombolysis. After subtracting the time needed for the diagnostic work-up, the net time gain was 28Ϯ12 minutes (meanϮSD).

Rivaroxaban Does Not Increase Hemorrhage after Thrombolysis in Experimental Ischemic Stroke

“…In the warfarin group, INR was assessed by a point-of-care coagulometer (Coaguchek XS, Roche, Penzberg, Germany) 19 before surgery to assure effective systemic anticoagulation in each individual animal (INR 2 to 3; Supplementary Information).…”

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

“…The current study identified an excellent correlation between the POC and the SCA INR, similar to that shown in previous studies. This finding demonstrates that the POC device is accurate, reliable and comparable to the SCA INR for use in patients with long-term use of oral anticoagulants 4,5,8,10 . POC could be useful in several situations, as patients without access to a medical laboratory could achieve better control with OAT 6 ; and in patients with acute IS who are within the therapeutic window for thrombolysis, evaluating INR using POC could be performed in the pre-hospital emergency medical service or in the hospital emergency room, reducing the time to treatment.…”

“…In a previous study, POC INR was precise for emergency management of thrombolysis in patients with acute IS and reduced the interval to INR results. The time gain using the POC compared to INR was 28 minutes 8 . This delay could compromised the effectiveness of thrombolysis in acute stroke care.…”

Point-of-care test (POCT) INR: hope or illusion?

“…The efficacy of thrombolysis in acute cerebrovascular accidents strongly depends on the interval between the onset of symptoms and administration of thrombolytic therapy [12]. Rizos et al [13] observed significant and clinically relevant time to onset of thrombolytic therapy, 28 ± 12 minutes with the use of INR-POCT.…”