Clinical Evaluation of the i-STAT Kaolin Activated Clotting Time (ACT) Test in Different Clinical Settings in a Large Academic Urban Medical Center

Abstract

Historically, it has been difficult for hospitals to change methods for activated clotting time (ACT) testing because of differences in ACT values obtained with different instruments, wide differences in target ranges used in different procedures, and the difficulty of performing crossover studies at the bedside in critical care situations. There are limited published data comparing the i-STAT (Abbott Point of Care, Princeton, NJ) kaolin ACT with the Medtronic ACT Plus (Medtronic, Minneapolis, MN). The i-STAT system can perform ACT testing in addition to testing of a number of critical care analytes and may offer potential advantages over other ACT analyzers. Comparison of ACT values on 121 simultaneous split-sample tests yielded an R(2) of 0.88 with i-STAT = 0.79 Medtronic + 72.0. The Pearson correlation was R = 0.94, indicating statistically significant correlation between the 2 methods. Based on this comparison, we were able to implement the i-STAT ACT throughout our institution without changing target ranges for any individual procedure.

Point-of-Care Measurement of Activated Clotting Time for Cardiac Surgery as measured by the Hemochron Signature Eliteand the Abbott i-STAT: Agreement, Concordance, and Clinical Reliability

“…Another method, as used in the i-STAT (Abbot Point-of-Care, Princeton, NJ, USA), is based on the electrochemical detection of a product derived from thrombin dependent cleavage of a substrate other than fibrinogen (Phenylalanin-Pipecolyl-Arginin-NH 3 -C 6 H 4 -NH-C 6 H 4 -OCH 3 ). 5 While the former methods are affected by thrombin generation, platelet aggregation, and fibrin polymerization, the latter assay only depends on thrombin generation, potentially resulting in measurements more precisely reflecting Heparins antithrombin properties. Although both methods are approved for clinical use, their reproducibility, agreement, and interchangeability have not been well investigated so far.…”

Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery

“…Unfractionated heparin, an indirect thrombin inhibitor, is the drug of choice for anticoagulation during cardiac surgery because of its: (a) prompt onset; (b) ease of monitoring by point-of-care testing (POCT); and (c) rapid neutralization with protamine. [1][2][3] The antithrombotic characteristics of the heparin are directly related to the complex structure of the molecule. Unfractionated heparin, which is generally used in cardiac surgery, consists of a polysaccharide mixture of low-molecular weight (LMW) fractions (short chain length) and high-molecular weight fractions (HMW) that interact differently with thrombin (range from 1,000 -50,000 Daltons).…”

Assessment of a portable prothrombin time analyzer (CoaguChek‐XS) in dogs

“…[4][5][6][7][8][9][10] Such devices are also penetrating the veterinary market, and 2 POC coagulation analyzers have been evaluated in dogs. 11,12 The CoaguChek-XS a is a second-generation, portable, battery-powered, laser photometer, weighing 175 g (batteries included) and fits in a human hand ( Figure 1).…”