Literature DB >> 12568171

Point-of-care and standard laboratory coagulation testing during cardiovascular surgery: balancing reliability and timeliness.

J C Fitch1, G P Mirto, K L Geary, D W Byrne, R L Hines.   

Abstract

OBJECTIVE: The use of point-of-care technology has increased faster than efforts to validate its effectiveness compared to standard laboratory testing modalities. To address this issue with a current point-of-care coagulation system (HEMOCHRON Jr, International Technidyne Corporation (ITC), Edison, NJ), we designed a study to test the hypothesis that data obtained from point-of-care coagulation equipment correlates with data obtained from standard laboratory coagulation equipment. One of the potential advantages gained using point-of-care testing is the ability to obtain more rapid results. To address this issue, turnaround time, defined as the elapsed time (in minutes) from when the sample was acquired from the patient until the investigators knew the results, was also determined.
METHODS: Following Human Investigation Committee approval and informed consent, a prospective study was conducted to compare results obtained from point-of-care coagulation equipment with those results obtained from standard laboratory coagulation equipment. The study was performed in three groups of patients undergoing cardiovascular surgery, each requiring different levels of anticoagulation.
RESULTS: Of the 83 patients who met the inclusion criteria, the correlation (combining data from groups 1-3) between results obtained from point-of-care and standard laboratory prothrombin time was r = 0.867, p < 0.001. The correlation (group 3) between point-of-care and standard laboratory international normalized ratio was r = 0.943, p < 0.001. The correlation (combining data from groups 1 &amp; 2) between point-of-care and standard laboratory activated partial thromboplastin time was r = 0.825, p < 0.001. Median turnaround time for the standard laboratory was 90 minutes, with a mean turnaround time of 74 to 78 minutes, depending upon the group. In contrast, the median turnaround time for point-of-care testing was two minutes and 14 seconds.
CONCLUSIONS: The results from this study population reveal that data obtained from point-of-care prothrombin time, international normalized ratio and activated partial thromboplastin time results correlate with results obtained from standard laboratory coagulation testing. The value of obtaining reliable results in a timely fashion offers a potential advantage for point-of-care testing in dinical situations, such as in the operating room, where saving time may translate into financial savings.

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Year:  1999        PMID: 12568171     DOI: 10.1023/a:1009934804369

Source DB:  PubMed          Journal:  J Clin Monit Comput        ISSN: 1387-1307            Impact factor:   2.502


  19 in total

1.  Sensitivity, specificity, and reproducibility of four measures of laboratory turnaround time.

Authors:  P N Valenstein; K Emancipator
Journal:  Am J Clin Pathol       Date:  1989-04       Impact factor: 2.493

2.  Minimum discard volume from arterial catheters to obtain coagulation studies free of heparin effect.

Authors:  A C Reinhardt; A S Tonneson; A Bracey; S K Goodnough
Journal:  Heart Lung       Date:  1987-11       Impact factor: 2.210

3.  Statistical methods for assessing agreement between two methods of clinical measurement.

Authors:  J M Bland; D G Altman
Journal:  Lancet       Date:  1986-02-08       Impact factor: 79.321

4.  Intraoperative measurement of activated partial thromboplastin time and prothrombin time by a portable laser photometer in patients following cardiopulmonary bypass.

Authors:  G A Nuttall; W C Oliver; F M Beynen; J J Dull; M J Murray; W L Nichols
Journal:  J Cardiothorac Vasc Anesth       Date:  1993-08       Impact factor: 2.628

5.  Does the emergency department need a dedicated stat laboratory? Continuous quality improvement as a management tool for the clinical laboratory.

Authors:  S Saxena; E T Wong
Journal:  Am J Clin Pathol       Date:  1993-12       Impact factor: 2.493

6.  Comparison of bedside coagulation monitoring tests with standard laboratory tests in patients after cardiac surgery.

Authors:  D L Reich; M J Yanakakis; F P Vela-Cantos; M DePerio; E Jacobs
Journal:  Anesth Analg       Date:  1993-10       Impact factor: 5.108

Review 7.  Hemostasis defects associated with cardiac surgery, prosthetic devices, and other extracorporeal circuits.

Authors:  R L Bick
Journal:  Semin Thromb Hemost       Date:  1985-07       Impact factor: 4.180

8.  Correction of instrument- and reagent-based differences in determination of the International Normalized Ratio (INR) for monitoring anticoagulant therapy.

Authors:  J L van Rijn; N A Schmidt; W P Rutten
Journal:  Clin Chem       Date:  1989-05       Impact factor: 8.327

9.  Effect of analytic uncertainty of conventional and point-of-care assays of activated partial thromboplastin time on clinical decisions in heparin therapy.

Authors:  M Werner; J V Gallagher; M S Ballo; D S Karcher
Journal:  Am J Clin Pathol       Date:  1994-08       Impact factor: 2.493

10.  On-site prothrombin time, activated partial thromboplastin time, and platelet count. A comparison between whole blood and laboratory assays with coagulation factor analysis in patients presenting for cardiac surgery.

Authors:  G J Despotis; S A Santoro; E Spitznagel; K M Kater; P Barnes; J L Cox; D G Lappas
Journal:  Anesthesiology       Date:  1994-02       Impact factor: 7.892

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  4 in total

1.  Does a delay in performing an activated clotting (ACT) test really matter? A study in nonheparinized blood and a single ACT machine.

Authors:  Bridget M Philip; John G Brock-Utne; Harry J M Lemmens; Richard A Jaffe; Paul E Shuttleworth
Journal:  J Extra Corpor Technol       Date:  2008-09

Review 2.  Mapping turnaround times (TAT) to a generic timeline: a systematic review of TAT definitions in clinical domains.

Authors:  Bernhard Breil; Fleur Fritz; Volker Thiemann; Martin Dugas
Journal:  BMC Med Inform Decis Mak       Date:  2011-05-24       Impact factor: 2.796

3.  Cost-Utility and Budget Impact Analysis of Implementing Anticoagulation Clinics and Point-of-Care Monitoring Devices in Anticoagulated Patients in Argentina.

Authors:  Osvaldo Ulises Garay; Gonzalo Guiñazú; Yolanda Patricia Adamczuk; Cristina Duboscq
Journal:  Pharmacoecon Open       Date:  2022-07-14

Review 4.  Diagnostic Modalities in Critical Care: Point-of-Care Approach.

Authors:  Sasa Rajsic; Robert Breitkopf; Mirjam Bachler; Benedikt Treml
Journal:  Diagnostics (Basel)       Date:  2021-11-25
  4 in total

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