Key result
Point-of-care devices for monitoring warfarin via PT-INR show very good correlation to standard reference laboratory testing and are acceptable for use in patient care.
Why the study?
Are point-of-care devices accurate and reliable for monitoring warfarin and parenteral direct thrombin inhibitors compared to standard laboratory testing?
Are point-of-care devices accurate and reliable for monitoring warfarin and parenteral direct thrombin inhibitors compared to standard laboratory testing?
Point-of-care devices for monitoring warfarin anticoagulation provide acceptable accuracy compared to reference laboratories and are increasingly used in clinical practice.
Supports point-of-care PT-INR monitoring in practice; leaves open need for outcome trials before guideline endorsement.
OBJECTIVE: To review the availability, mechanisms, limitations, and clinical application of point-of-care (POC) devices used in the management of warfarin and parenteral direct thrombin inhibitors. DATA SOURCES: Scientific articles were identified through a MEDLINE search (1966-August 2004), manufacturer Web sites, additional references listed in articles and Web sites, and abstracts from scientific meetings. STUDY SELECTION AND DATA EXTRACTION: English-language literature from clinical trials was reviewed to evaluate the accuracy, reliability, and clinical application of POC monitoring devices. DATA SYNTHESIS: The prothrombin time expressed as the international normalized ratio (PT-INR) is a well-established test for monitoring warfarin anticoagulation. Multiple devices are available for POC testing. Because there is no universally accepted standard, the performance of each device is typically tested against a standard test performed in a reference laboratory. Performance of currently available devices, as measured by correlations to a standard reference laboratory PT-INR, may be considered very good and acceptable for use in patient care. Utilization of patient self-testing and patient self-monitoring of warfarin anticoagulation using POC devices is increasing. Parenteral direct thrombin inhibitors are typically monitored using a standard laboratory activated partial thromboplastin time. Some research has shown that POC monitoring of direct thrombin inhibitors using the ecarin clotting time is helpful for patients undergoing cardiopulmonary bypass surgery, although that test is not readily available. CONCLUSIONS: POC testing for anticoagulation therapy has been available for >20 years. Multiple POC devices are available to monitor warfarin. There is some variability in results between devices and between reagents used in the same device. Despite these limitations, POC monitoring of warfarin via the PT-INR is an integral part of clinical practice. Additional research evaluating POC monitoring of direct thrombin inhibitors is necessary.
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Spinler et al. (2005) conducted a review in Patients requiring anticoagulation monitoring. Point-of-care (POC) monitoring devices vs. Standard reference laboratory testing was evaluated on Accuracy, reliability, and clinical application. Point-of-care devices for monitoring warfarin via PT-INR show very good correlation to standard reference laboratory testing and are acceptable for use in patient care.
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