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

Abstract

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.

Decision-Making Process for the Management of Acute Stroke in Patients on Oral Anticoagulant: From Guidelines to Clinical Routine

“…Point of care (POC) testing of the INR is not recommended to date by European and American guidelines before intravenous thrombolysis for assessing VKA activity. One study suggested the comparability of POC and central laboratory INR measurements ( 43 ). However, some discrepancies between these two evaluations still limit their usefulness in clinical practise and we would not recommend IVT for patients with INR > 1.2 measured with a POC.…”

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

“…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 .…”

Differences in Body Composition among Patientsafter Hemorrhagic and Ischemic Stroke

“…Accordingly, the World Health Organization and World Stroke Organization recommend expanding efforts to raise awareness of population risk factors for stroke as well as implementing effective prevention strategies at global, regional, and national levels. Created by the European Parliament in 2004, the Stroke Alliance for Europe recommends primary and secondary prevention, improvement of health care, rehabilitation, and assessment of quality of life [16,17]. According to these recommendations, secondary prevention should consist of detecting risk factors and combating them through lifestyle changes and appropriate pharmacological management [18].…”