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Reliability of Point-of-Care Testing of INR in Acute Stroke

Published online by Cambridge University Press:  02 December 2014

Theresa L. Green ,
Adnan Mansoor ,
Nancy Newcommon ,
Caroline Stephenson ,
Eileen Stewart  and
Michael D. Hill
Theresa L. Green
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, and Calgary Laboratory Services, Calgary, AB, Canada
Adnan Mansoor
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, and Calgary Laboratory Services, Calgary, AB, Canada
Nancy Newcommon
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, and Calgary Laboratory Services, Calgary, AB, Canada
Caroline Stephenson
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, and Calgary Laboratory Services, Calgary, AB, Canada
Eileen Stewart
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, and Calgary Laboratory Services, Calgary, AB, Canada
Michael D. Hill
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, and Calgary Laboratory Services, Calgary, AB, Canada
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Abstract

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Background:

In the emergency department, portable point-of-care testing (POCT) coagulation devices may facilitate stroke patient care by providing rapid International Normalized Ratio (INR) measurement. The objective of this study was to evaluate the reliability, validity, and impact on clinical decision-making of a POCT device for INR testing in the setting of acute ischemic stroke (AIS).

Methods:

A total of 150 patients (50 healthy volunteers, 51 anticoagulated patients, 49 AIS patients) were assessed in a tertiary care facility. The INR’s were measured using the Roche Coaguchek S and the standard laboratory technique.

Results:

The interclass correlation coefficient and 95% confidence interval between overall POCT device and standard laboratory value INRs was high (0.932 (0.69 - 0.78). In the AIS group alone, the correlation coefficient and 95% CI was also high 0.937 (0.59 - 0.74) and diagnostic accuracy of the POCT device was 94%.

Conclusions:

When used by a trained health professional in the emergency department to assess INR in acute ischemic stroke patients, the CoaguChek S is reliable and provides rapid results. However, as concordance with laboratory INR values decreases with higher INR values, it is recommended that with CoaguChek S INRs in the > 1.5 range, a standard laboratory measurement be used to confirm the results.

Résumé:

<span class='bold'>RÉSUMÉ:</span><span class='bold'><span class='italic'>Contexte:</span></span>

À la salle d’urgence, les appareils portatifs pour analyse de l’INR au point d’intervention (API) peuvent faciliter les soins prodigués aux patients atteints d’accidents vasculaires cérébraux (AVC). Le but de cette étude était d’évaluer la fiabilité, la validité et l’impact sur la décision clinique de l'INR effectué au moyen d’un appareil d'API dans le contexte de l'AVC aigu.

<span class='bold'><span class='italic'>Méthodes:</span></span>

Cent cinquante patients, soit 50 volontaires sains, 51 patients anticoagulés et 49 patients atteints d’un AVC aigu, ont été évalués dans un centre de soins tertiaires. Le Roche Coaguchek S et la technique standard de laboratoire ont été utilisés pour mesurer l’INR. Résultats : Globalement, le coefficient de corrélation interclasse et l’intervalle de confiance à 95% entre la valeur de l’INR mesurée par l’appareil d’API et la valeur mesurée par la technique standard de laboratoire était élevée (CC0,932; IC95% 0,69 à 0,78). Dans le groupe de patients présentant un d’AVC aigu, le coefficient de correlation était également élevé (0,937; IC95% 0,59 à 0,74) et la précision diagnostique de l’appareil d'API était 94%.

<span class='bold'><span class='italic'>Conclusions:</span></span>

: Quand le CoaguChek S est utilisé à la salle d’urgence par un professionnel de la santé entraìné pour mesurer l’INR chez des patients atteints d’un AVC ischémique aigu, l’appareil est fiable et rapide. Cependant, étant donné que la concordance entre les valeurs d’INR obtenues au moyen de l’appareil et par la technique standard diminue lorsque les valeurs d’INR sont plus élevées, il est recommandé d’obtenir confirmation des résultats par la méthode standard quand la valeur obtenue par CoaguChek S est > 1,5.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 3 , July 2008 , pp. 348 - 351
Copyright
Copyright © The Canadian Journal of Neurological 2008

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