Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Curtis, Corbin M.; Kost, Gerald J.; Louie, Richard F.; Sonu, Rebecca; Ammirati, Erika B.; Sumner, Stephanie L.

doi:10.1097/poc.0b013e31825a9d3a

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…There have been some studies describing benefits of POC INR in managing patients on warfarin in different settings. Several descriptive case studies have highlighted the benefit of POC INR testing by pharmacists for patients who live in rural or remote areas with limited access to hospitals and medical clinics [ 9 , 10 ]. A retrospective cohort study found improved INR control in patients at cardiology clinics who took part in a nurse-run, mobile POC anticoagulation therapy clinic [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting

Rossiter

Soor

Telner

et al. 2013

International Journal of Family Medicine

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Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; P = 0.03). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings.

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Section: Discussionmentioning

confidence: 99%

A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting

Rossiter

Soor

Telner

et al. 2013

International Journal of Family Medicine

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“…Their application is increasing as they enable swift clinical decisions due to rapid therapeutic turnaround time. 1 In hemostasis field, a number of POCTs (activated clotting time, thromboelastography, platelet function, d -dimer, and so on) are available but measurement of international normalized ratio (INR) for monitoring warfarin therapy is the main test of this domain. 2 Despite the emergence of novel oral anticoagulants, warfarin is still the most commonly used oral anticoagulant worldwide.…”

Section: Introductionmentioning

confidence: 99%

Prospective Comparison of Point-of-Care Device and Standard Analyzer for Monitoring of International Normalized Ratio in Outpatient Oral Anticoagulant Clinic

Moiz

Rashid

Hasan

et al. 2018

Clin Appl Thromb Hemost

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Point-of-care testing (POCT) coagulometers are increasingly being used in the hospital setting and patients' self-testing. We determined the agreement of prothrombin time international normalized ratio (INR) results by POCT coagulometer and laboratory instrument through a comparative analysis and investigated whether the results of POCT coagulometer can reliably be used without being confirmed by standard laboratory analyzer. A total of 200 INR measurements by POCT coagulometer (CoaguChek XS Pro) and laboratory analyzer (Sysmex CS2000i) were compared using Passing-Bablok regression analysis and Bland-Altman plot. Agreement of the INR measurement was further analyzed in relation to dosing decision. The correlation of INR measurements between CoaguChek XS Pro and Sysmex CS2000i was excellent (correlation coefficient = 0.973). The overall mean difference was 0.21 INR ± 0.32 (range: 1.7-0.44). The mean difference was found to get increased as INR results increased and was 0.09 in the subtherapeutic range (≤1.9 INR), 0.29 INR in the therapeutic range (2.0-3.0 INR), while 0.4 INR in the supratherapeutic range (>3.0 INR). The overall agreement was excellent (κ = 0.916) and overall 11 (5.5%) of 200 INR measurements showed a difference in dosing decision between the 2 instruments. The positive bias of POC-INR is evident in the supratherapeutic range which could affect the dosing decision requiring confirmation with the laboratory INR measurement.

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“…In order to achieve timely results alongside ensuring patient convenience and satisfaction, robust technology could be considered after meticulous cost-benefit analysis. A study by Curtis et al [5] reported improved patient quality of care with the application of POCT. It enabled prompt clinical decisions supported by a quick therapeutic TAT.…”

Section: Discussionmentioning

confidence: 99%

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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Point-of-Care Hematology and Coagulation Testing in Primary, Rural Emergency, and Disaster Care Scenarios

Cited by 12 publications

References 18 publications

A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting

A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting

Prospective Comparison of Point-of-Care Device and Standard Analyzer for Monitoring of International Normalized Ratio in Outpatient Oral Anticoagulant Clinic

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

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