1
|
Cortina-de-la-Rosa E, Izaguirre-Ávila R, Ramírez-Hernández A, Romero-Arroyo MO, Cortés-Cortés K. Reliability of International Normalized Ratio Results in the CoaguChek Pro II System in a Clinical Setting. Clin Appl Thromb Hemost 2023; 29:10760296231216451. [PMID: 38018118 PMCID: PMC10686019 DOI: 10.1177/10760296231216451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
The National Institute of Cardiology has previously used the CoaguChek® XS Plus system (Roche Diagnostics International Ltd), comparing capillary blood prothrombin time/international normalized ratio (PT/INR) results with those obtained using BCS-XP/Thromborel (Siemens). We assessed the reliability of PT/INR results using the third-generation CoaguChek Pro II system, the CoaguChek XS Plus system, and cobas® t 411 for citrated plasma analysis. Venous and capillary PT/INR were measured (N = 204). Spearman's correlation, Bland-Altman, and concordance analysis between methods were conducted. Spearman's correlation coefficients between venous/capillary INR were high for CoaguChek Pro II versus CoaguChek XS Plus (r = 0.994), CoaguChek Pro II versus cobas t 411 (r = 0.967), and CoaguChek XS Plus versus cobas t 411 (r = 0.968). Good concordance was observed among capillary methods (concordance coefficient [κ] = 0.888) and remaining relationships (P < .001 for all): cobas t 411 versus CoaguChek XS Plus (κ = 0.696) and cobas t 411 versus CoaguChek Pro II (κ = 0.684). In conclusion, good agreement was observed between CoaguChek Pro II, CoaguChek XS Plus, and cobas t 411.
Collapse
Affiliation(s)
| | - Raúl Izaguirre-Ávila
- Department of Hematology, National Institute of Cardiology Ignacio Chávez, México City, México
| | | | | | - Karen Cortés-Cortés
- Department of Hematology, National Institute of Cardiology Ignacio Chávez, México City, México
| |
Collapse
|
2
|
Fonseca MES, Balbi GGM, Signorelli F, Gouvea CP, de Andrade DCO. CoaguChek® XS versus standard laboratory prothrombin time for anticoagulant monitoring in patients with antiphospholipid syndrome. Lupus 2022; 31:565-574. [PMID: 35266798 DOI: 10.1177/09612033221086134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The standard of care for thrombotic antiphospholipid syndrome (APS) is anticoagulation with vitamin K antagonists (VKAs). Prothrombin time, and its corresponding international normalized ratio (INR), is the laboratory test routinely performed to assess anticoagulation. Self-management of VKA therapy using point-of-care (POC) devices seems to be an attractive option. PURPOSE/OBJECTIVE To evaluate the accuracy of a POC device (CoaguChek XS) in APS patients by comparing it with venous laboratory INR. Furthermore, we analyzed whether other clinical and laboratory features could interfere with the CoaguChek XS results. PATIENTS AND METHODS This is a single-center cross-sectional study with 94 APS patients from a tertiary rheumatology clinic performed from August 2014 to March 2015. The comparison between CoaguChek XS and venous laboratory INR results was evaluated using the coefficient of determination (r) followed by the Bland-Altman test. A paired t-test was also applied. A difference of up to ±0.5 INR unit between the two systems was considered clinically acceptable. RESULTS The mean CoaguChek-INR was 2.94 ± 1.41 and venous laboratory INR was 2.43±0.86, with a correlation coefficient (r) of 0.95. Categorizing INR values in ranges (INR <2, INR 2-3, INR 3-4, and INR >4), we found that the INR >4 group presented a lower correlation (r = 0.64) compared to the other ranges (p < 0.05). Although both methods were highly correlated, CoaguChek XS showed higher values than the venous laboratory INR, with an increased average of 0.42 ± 0.54. Therefore, we proposed a simple linear regression model to predict the venous laboratory INR values, using results obtained from CoaguChek XS. A difference ≤0.5 INR unit between the two systems was observed in 57.4% of patients, and the aPL profile did not influence the results. CONCLUSION Although CoaguChek XS and venous laboratory INR demonstrated a good linear correlation in the group of INR ≤4, extra caution should be taken in APS patients, since a reasonable proportion of patients can present differences in INR results that are not acceptable. We do not recommend routine POC in APS patients.
Collapse
Affiliation(s)
| | - Gustavo G M Balbi
- Rheumatology Division, 117265University of São Paulo, São Paulo, Brazil.,Rheumatology Division, 424848Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Flavio Signorelli
- Rheumatology Division, 117265University of São Paulo, São Paulo, Brazil.,Rheumatology Division, 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Christiane P Gouvea
- Coagulation Division, Central Institute, University of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
3
|
Cohen H, Efthymiou M, Devreese KMJ. Monitoring of anticoagulation in thrombotic antiphospholipid syndrome. J Thromb Haemost 2021; 19:892-908. [PMID: 33325604 DOI: 10.1111/jth.15217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022]
Abstract
Anticoagulation is central to the management of thrombotic antiphospholipid syndrome (APS). The standard anticoagulant treatment for thrombotic APS is life-long warfarin or an alternative vitamin K antagonist. The role of direct oral anticoagulants for thrombotic APS is not established due to the lack of definitive evidence and has recently been addressed in international guidance. Other anticoagulant options include low molecular weight heparin, unfractionated heparin, and fondaparinux. In APS patients, lupus anticoagulant can affect phospholipid-dependent coagulation monitoring tests, so that they may not reflect true anticoagulation intensity. Accurate assessment of anticoagulation intensity is essential, to optimize anticoagulant dosing and facilitate thrombus resolution; minimize the risk of recurrent thrombosis or bleeding; inform assessment of whether recurrent thrombosis is related to breakthrough thrombosis while on therapeutic anticoagulation, subtherapeutic anticoagulation, non-adherence, or spurious results; and guide the management of bleeding. Knowledge of anticoagulant intensity also informs assessment and comparison of anticoagulation regimens in clinical studies. Considerations regarding anticoagulation dosing and/or monitoring of thrombotic APS patients underpin appropriate management in special situations, notably APS-related severe renal impairment, which can occur in APS or APS/systemic lupus erythematosus-related nephropathy or catastrophic APS; and APS-related thrombocytopenia. Anticoagulant dosing and monitoring in thrombotic APS patients also require consideration in anticoagulant-refractory APS and during pregnancy. In this review, we summarize the tests generally used in monitoring anticoagulant therapy, use of the main anticoagulants considered for thrombotic APS, lupus anticoagulant effects on anticoagulation monitoring tests, and strategies for appropriate anticoagulant monitoring in thrombotic APS.
Collapse
Affiliation(s)
- Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Katrien M J Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Department of Diagnostic Sciences, Ghent University Hospital, Ghent University, Ghent, Belgium
| |
Collapse
|
4
|
Levesque AA, Lewin AR, Rimsans J, Sylvester KW, Coakley L, Melanson F, Mallidi H, Mehra M, Givertz MM, Connors JM. Development of Multidisciplinary Anticoagulation Management Guidelines for Patients Receiving Durable Mechanical Circulatory Support. Clin Appl Thromb Hemost 2019; 25:1076029619837362. [PMID: 30907120 PMCID: PMC6714942 DOI: 10.1177/1076029619837362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 01/15/2023] Open
Abstract
Patients receiving durable mechanical circulatory support (MCS) require life-long anticoagulation with a vitamin K antagonist (VKA). Due to alternations in hemostasis, concomitant therapy with antiplatelet agents and critical illness, they are at increased risk of thromboembolic and bleeding complications compared with the general population managed on VKAs. To prevent thrombotic events, current guidelines recommend that patients with MCS receive long-term anticoagulation with a VKA to maintain a target international normalized ratio (INR) as specified by device manufacturers, but limited data exist regarding specific routine management of anticoagulation therapy and its potential complications. To optimize anticoagulation management and minimize risk in these patients, we have centralized anticoagulation management in a collaborative approach between the inpatient hemostatic and antithrombotic (HAT) stewardship service and between ambulatory anticoagulation management service (AMS) and the advanced heart disease team. Patients are followed by these three services beginning when the device is implanted and extending the duration that patients have the device. The teams include multiple clinicians from cardiac surgery, cardiology, hematology, pharmacy, nursing, case management, nutrition, and psychiatry, therefore, in order to standardize practice among clinicians without compromising patient centered decision making, we assembled an interdisciplinary team to create multiple treatment guidelines. In addition to a centralized and collaborative approach, our guidelines ensure seamless transitions of care between the inpatient and outpatient settings. We believe our approach has demontrated a positive improvement in the care of these challenging patients. In this article, we present our comprehensive centralized anticoagulation management approach for patients with left ventricular assist systems (LVAS).
Collapse
Affiliation(s)
- Amy A. Levesque
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA,
USA
| | - Andrea R. Lewin
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA,
USA
| | - Jessica Rimsans
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA,
USA
| | | | - Lara Coakley
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Frank Melanson
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Hari Mallidi
- Department of Cardiac Surgery, Brigham and Women’s Hospital, Boston, MA,
USA
| | - Mandeep Mehra
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Michael M. Givertz
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and
Women’s Hospital, Boston, MA, USA
| | - Jean M. Connors
- Department of Medicine, Division of Hematology, Brigham and Women’s
Hospital, Boston, MA, USA
| |
Collapse
|
5
|
Wool GD. Benefits and Pitfalls of Point-of-Care Coagulation Testing for Anticoagulation Management: An ACLPS Critical Review. Am J Clin Pathol 2019; 151:1-17. [PMID: 30215666 DOI: 10.1093/ajcp/aqy087] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives Point-of-care (POC) testing is generally less precise and has higher reagent costs per test than laboratory-based assays. However, POC hemostasis testing can offer significant advantages in particular situations: patient-managed warfarin therapy as well as rapid turnaround time heparin management for intraoperative patients. Of note, POC hemostasis testing is generally approved for the purposes of anticoagulation monitoring and is inferior to laboratory coagulation testing for the diagnosis of congenital or acquired coagulopathy. Methods The frequently used POC coagulation instruments for POC international normalized ratio and activated clotting time are reviewed, as well as their typical performance relative to central laboratory testing (where available). Results Several cases are discussed that highlight the benefits, as well as pitfalls, of POC coagulation testing. Conclusions POC coagulation testing for anticoagulation monitoring offers advantages in particular situations. Clear policies and protocols must be developed to guide proper use of POC versus central laboratory hemostasis testing.
Collapse
Affiliation(s)
- Geoffrey D Wool
- The Department of Pathology, University of Chicago, Chicago, IL
| |
Collapse
|
6
|
Okabayashi S, Ogawa S, Tanaka KA, Nishiyama T, Takeshita S, Nakayama Y, Nakajima Y, Sawa T, Mizobe T. A Comparative Study of Point-of-Care Prothrombin Time in Cardiopulmonary Bypass Surgery. J Cardiothorac Vasc Anesth 2018; 32:1609-1614. [DOI: 10.1053/j.jvca.2017.12.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Indexed: 11/11/2022]
|
7
|
Mbokota N, Schapkaitz E, Louw S. Verification of the qLabs international normalized ratio point-of-care device for monitoring of patients attending an anticoagulation clinic. Int J Lab Hematol 2018; 40:508-514. [PMID: 29761633 DOI: 10.1111/ijlh.12849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/29/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In the developing world, point-of-care (POC) testing for international normalized ratio (INR) plays an important role in the monitoring of patients on long-term warfarin therapy with limited access to healthcare ensuring safe and effective anticoagulation. A newly developed POC device for INR measurement by healthcare workers is the handheld qLabs POC device® (Micropoint Biotechnologies Incorporated, Guangdong, China). METHODS The qLabs POC device® was evaluated in 262 patients attending an anticoagulation clinic with regards to accuracy and precision of the INR results. The results were compared to the results obtained on the Stago STA R Max® coagulation analyzer (Stago Diagnostica, Paris, France) on a wide range of normal and abnormal results of clinical relevance. RESULTS The mean laboratory INR (2.50 ± 1.08) was significantly higher than the qLabs POC device® INR (2.38 ± 1.07) (P < .0001). The correlation coefficient (r) was .88, the slope coefficient was 1.0 (CI, 0.8-1.2), and the intercept was -0.10 (CI, -0.50 to 0.30). The mean of the differences was -0.13% (CI, -0.19 to -0.06). Dosage concordance was 85.46% and clinical agreement was 92.37%. However, clinical agreement was 42.42% in the subgroup above the target range (>3.5). The imprecision was within acceptable limits (<5%) and the error message rate was 4.38%. CONCLUSION In conclusion, the qLabs POC device® is accurate and precise with high levels of dosage concordance and clinical agreement for INR values within and below the target range.
Collapse
Affiliation(s)
- N Mbokota
- Department of Molecular Medicine and Haematology, University of Witwatersrand Medical School, Johannesburg, South Africa
| | - E Schapkaitz
- Department of Molecular Medicine and Haematology, University of Witwatersrand Medical School, Johannesburg, South Africa
| | - S Louw
- Department of Molecular Medicine and Haematology, University of Witwatersrand Medical School, Johannesburg, South Africa
| |
Collapse
|
8
|
Jourdi G, Lefèbvre S, Le Bonniec B, Curis E, Gaussem P, Lattard V, Siguret V. Thrombin generation test: A reliable tool to evaluate the pharmacodynamics of vitamin K antagonist rodenticides in rats. PESTICIDE BIOCHEMISTRY AND PHYSIOLOGY 2018; 146:19-24. [PMID: 29626988 DOI: 10.1016/j.pestbp.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 02/01/2018] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
Vitamin K antagonist rodenticide pharmacodynamics (PD) is studied in rodents with traditional laboratory tests. We wondered if thrombin generation test (TGT) could add value. Difethialone (10 mg/kg) was administered per os to 97 OFA-Sprague Dawley rats. PD was studied over a 72 h-period using the Calibrated Automated Thrombogram on platelet poor plasma before and after intoxication (3 female and 3 male rats for each 13 time points) and TGT parameters were compared with the prothrombin time (PT) and vitamin K dependent factor activities previously reported. Following intoxication, preliminary tests evidenced rapid and full inhibition of thrombin generation triggered with 5 or 20 pM human recombinant tissue factor. To study the evolution of TGT parameters following difethialone intake, we adapted the test by complementing intoxicated rat samples with pooled normal rat plasma (3/1, v/v). Adapted TGT confirmed the known higher procoagulant basal level in females compared to males through higher endogenous thrombin potential (ETP) and peak height (PH) (p < 0.0001 and p = 0.0003, respectively). An exponential model fitted well the PH and ETP decay after intoxication. In contrast to PT, the decreases were observed immediately following VKA intake and had comparable time to halving values: 10.5 h (95% CI [8.2; 13.6]) for ETP and 10.4 h (95% CI [7.8; 14.1]) for PH. The decrease of FVII and FX preceded that of PH, ETP and FII while FIX decreased later on, contributing to the severe hypo-coagulability. We demonstrated that TGT performed in samples of intoxicated rats complemented with normal plasma is a reliable tool for evaluation of VKA rodenticide PD in rats.
Collapse
Affiliation(s)
- Georges Jourdi
- INSERM UMR_S1140, Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France.
| | - Sebastien Lefèbvre
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, 1, avenue Bourgelat, 69280 Marcy l'Etoile, Lyon, France.
| | - Bernard Le Bonniec
- INSERM UMR_S1140, Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France.
| | - Emmanuel Curis
- Laboratoire de biomathématiques & UMR_S1144, Université Paris Descartes, Sorbonne Paris Cité & DBIM, Hôpital Saint-Louis, AP-HP, 4 avenue de l'Observatoire, 75006 Paris, France.
| | - Pascale Gaussem
- Service d'hématologie biologique, Hôpital Européen Georges Pompidou, AP-HP & INSERM UMR_S1140, Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France.
| | - Virginie Lattard
- USC 1233 RS2GP, VetAgro Sup, INRA, Univ Lyon, F-69280, 1, avenue Bourgelat, 69280 Marcy l'Etoile, Lyon, France.
| | - Virginie Siguret
- Service d'hématologie biologique, Hôpital Lariboisière, AP-HP & INSERM UMR_S1140, Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l'Observatoire, 75006 Paris, France.
| |
Collapse
|
9
|
Moiz B, Rashid A, Hasan M, Jafri L, Raheem A. Prospective Comparison of Point-of-Care Device and Standard Analyzer for Monitoring of International Normalized Ratio in Outpatient Oral Anticoagulant Clinic. Clin Appl Thromb Hemost 2018; 24:1153-1158. [PMID: 29374969 PMCID: PMC6714735 DOI: 10.1177/1076029617752247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Bushra Moiz
- 1 Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Anila Rashid
- 1 Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Hasan
- 1 Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Lena Jafri
- 1 Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Raheem
- 1 Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
10
|
Joubert J, van Zyl M, Raubenheimer J. Performance evaluation of the microINR®
point-of-care INR-testing system. Int J Lab Hematol 2017; 40:115-122. [DOI: 10.1111/ijlh.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/31/2017] [Indexed: 12/01/2022]
Affiliation(s)
- J. Joubert
- National Health Laboratory Service (NHLS); Universitas Hospital; Haematology Academic Laboratories; Bloemfontein South Africa
- Department of Haematology and Cell Biology; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - M.C. van Zyl
- Department of Haematology and Cell Biology; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - J. Raubenheimer
- Department of Biostatistics; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| |
Collapse
|
11
|
Baker WS, Albright KJ, Berman M, Spratt H, Mann PA, Unabia J, Petersen JR. POCT PT INR — Is it adequate for patient care? A comparison of the Roche Coaguchek XS vs. Stago Star vs. Siemens BCS in patients routinely seen in an anticoagulation clinic. Clin Chim Acta 2017; 472:139-145. [DOI: 10.1016/j.cca.2017.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022]
|
12
|
Riva N, Vella K, Meli S, Hickey K, Zammit D, Calamatta C, Makris M, Kitchen S, Ageno W, Gatt A. A comparative study using thrombin generation and three different INR methods in patients on Vitamin K antagonist treatment. Int J Lab Hematol 2017; 39:482-488. [DOI: 10.1111/ijlh.12668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- N. Riva
- Department of Pathology; University of Malta; Msida Malta
| | - K. Vella
- Coagulation Medicine Laboratory; Department of Pathology; Mater Dei Hospital; Msida Malta
| | - S. Meli
- Point-of-Care Testing Committee; Department of Pathology; Mater Dei Hospital; Msida Malta
| | - K. Hickey
- Sheffield Haemophilia and Thrombosis Centre; University of Sheffield; Sheffield UK
| | - D. Zammit
- Coagulation Medicine Laboratory; Department of Pathology; Mater Dei Hospital; Msida Malta
| | - C. Calamatta
- Point-of-Care Testing Committee; Department of Pathology; Mater Dei Hospital; Msida Malta
| | - M. Makris
- Sheffield Haemophilia and Thrombosis Centre; University of Sheffield; Sheffield UK
| | - S. Kitchen
- Sheffield Haemophilia and Thrombosis Centre; University of Sheffield; Sheffield UK
| | - W. Ageno
- Department of Clinical and Experimental Medicine; University of Insubria; Varese Italy
| | - A. Gatt
- Department of Pathology; University of Malta; Msida Malta
- Coagulation Medicine Laboratory; Department of Pathology; Mater Dei Hospital; Msida Malta
- Point-of-Care Testing Committee; Department of Pathology; Mater Dei Hospital; Msida Malta
| |
Collapse
|
13
|
Cohen H, Doré CJ, Clawson S, Hunt BJ, Isenberg D, Khamashta M, Muirhead N. Rivaroxaban in antiphospholipid syndrome (RAPS) protocol: a prospective, randomized controlled phase II/III clinical trial of rivaroxaban versus warfarin in patients with thrombotic antiphospholipid syndrome, with or without SLE. Lupus 2015; 24:1087-94. [PMID: 25940537 PMCID: PMC4527976 DOI: 10.1177/0961203315581207] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/17/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The current mainstay of the treatment of thrombotic antiphospholipid syndrome (APS) is long-term anticoagulation with vitamin K antagonists (VKAs) such as warfarin. Non-VKA oral anticoagulants (NOACs), which include rivaroxaban, have been shown to be effective and safe compared with warfarin for the treatment of venous thromboembolism (VTE) in major phase III prospective, randomized controlled trials (RCTs), but the results may not be directly generalizable to patients with APS. AIMS The primary aim is to demonstrate, in patients with APS and previous VTE, with or without systemic lupus erythematosus (SLE), that the intensity of anticoagulation achieved with rivaroxaban is not inferior to that of warfarin. Secondary aims are to compare rates of recurrent thrombosis, bleeding and the quality of life in patients on rivaroxaban with those on warfarin. METHODS Rivaroxaban in antiphospholipid syndrome (RAPS) is a phase II/III prospective non-inferiority RCT in which eligible patients with APS, with or without SLE, who are on warfarin, target international normalized ratio (INR) 2.5 for previous VTE, will be randomized either to continue warfarin (standard of care) or to switch to rivaroxaban. Intensity of anticoagulation will be assessed using thrombin generation (TG) testing, with the primary outcome the percentage change in endogenous thrombin potential (ETP) from randomization to day 42. Other TG parameters, markers of in vivo coagulation activation, prothrombin fragment 1.2, thrombin antithrombin complex and D-dimer, will also be assessed. DISCUSSION If RAPS demonstrates i) that the anticoagulant effect of rivaroxaban is not inferior to that of warfarin and ii) the absence of any adverse effects that cause concern with regard to the use of rivaroxaban, this would provide sufficient supporting evidence to make rivaroxaban a standard of care for the treatment of APS patients with previous VTE, requiring a target INR of 2.5.
Collapse
Affiliation(s)
- H Cohen
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - C J Doré
- University College London Comprehensive Clinical Trials Unit, Gower Street, London, UK
| | - S Clawson
- University College London Comprehensive Clinical Trials Unit, Gower Street, London, UK
| | - B J Hunt
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Haematology, Kings College London, London, UK
| | - D Isenberg
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
| | - M Khamashta
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK Department of Rheumatology, Kings College London, London, UK
| | - N Muirhead
- University College London Comprehensive Clinical Trials Unit, Gower Street, London, UK
| |
Collapse
|
14
|
Efthymiou M, Lawrie AS, Mackie I, Arachchillage D, Lane PJ, Machin S, Cohen H. Thrombin generation and factor X assays for the assessment of warfarin anticoagulation in thrombotic antiphospholipid syndrome. Thromb Res 2015; 135:1191-7. [DOI: 10.1016/j.thromres.2015.03.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/12/2015] [Accepted: 03/30/2015] [Indexed: 12/13/2022]
|
15
|
Abstract
Point-of-care testing (POCT) refers to any diagnostic test administered outside the central laboratory at or near the location of the patient. By performing the sample collection and data analysis steps in the same location POCT cuts down on transport and processing delays, resulting in the rapid feedback of test results to medical decision-makers. Over the past decades the availability and use of POCT have steadily increased in Europe and throughout the international community. However, concerns about overall utility and the reliability of benefits to patient care have impeded the growth of POCT in some areas. While there is no agreed-upon standard for how success should be judged, the increases in speed and mobility provided by POCT can lead to substantial advantages over traditional laboratory testing. When properly utilized, POCT has been shown to yield measurable improvements in patient care, workflow efficiency, and even provide significant financial benefits. However, important organizational and quality assurance challenges must be addressed with the implementation of POCT in any health care environment. To ensure maximal benefits it may be necessary to evaluate critically and restructure existing clinical pathways to capitalize better on the rapid test turnaround times provided by POCT.
Collapse
Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Albert Huisman
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
16
|
Lai YF, Cheen MHH, Lim SH, Yeo FHI, Nah SC, Kong MC, Mya D, Lee LH, Ng HJ. The effects of fasting in Muslim patients taking warfarin. J Thromb Haemost 2014; 12:349-54. [PMID: 24354801 DOI: 10.1111/jth.12496] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anticoagulation with warfarin is influenced by dietary changes but the effect of fasting on warfarin therapy is unknown. OBJECTIVES To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before, during and after the Muslim fasting month (Ramadan) in stable warfarinised Muslim patients. METHODS/PATIENTS In this prospective study, weekly INR readings were taken at home visits from participating patients during three study periods: before, during and after Ramadan. Readings were blinded to patients and their primary physicians except for when pre-set study endpoints were reached. RESULTS Among 32 participating patients, mean INR increased by 0.23 (P = 0.006) during Ramadan from the pre-Ramadan month and decreased by 0.28 (P < 0.001) after Ramadan. There was no significant difference (P = 1.000) in mean INR between the non-Ramadan months. %TTR declined from 80.99% before Ramadan to 69.56% during Ramadan (P = 0.453). The first out-of-range INR was seen around 12.1 days (95% CI, 9.0-15.1) after the start of fasting and returned to range at about 10.8 days (95% CI, 7.9-13.7) after Ramadan. Time above range increased from 10.80% pre-Ramadan to 29.87% during Ramadan (P = 0.027), while time below range increased from 0.57% during Ramadan to 15.49% post-Ramadan (P = 0.006). No bleeding or thrombotic events were recorded. CONCLUSIONS Fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets. For patients maintained at the higher end of INR target ranges or at increased risk of bleeding, closer monitoring or dosage adjustment may be necessary during fasting.
Collapse
Affiliation(s)
- Y F Lai
- Department of Pharmacy, Singapore General Hospital, Singapore
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Bouwmeester C, Chim C. Pharmacist-managed oral anticoagulation therapy in the community setting. THE CONSULTANT PHARMACIST : THE JOURNAL OF THE AMERICAN SOCIETY OF CONSULTANT PHARMACISTS 2013; 28:280-294. [PMID: 23649677 DOI: 10.4140/tcp.n.2013.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Pharmacists are at the forefront when caring for patients requiring anticoagulation resulting from chronic conditions, complex medications therapy, or at risk for drug interactions. As a consequence, there is a greater need for pharmacist-managed anticoagulation clinics in the community setting. This article will review special considerations for oral anticoagulant therapy in the elderly, collaborative therapy management, establishment of policies and procedures, documentation of patient visits, patient counseling, and barriers to successful anticoagulation management. It will also discuss evidence-based guidelines for the use of oral anticoagulants and compare the agents currently approved by the Food and Drug Administration. Finally, barriers to anticoagulation management will be examined, including issues with adherence and communication with patients and health care providers.
Collapse
Affiliation(s)
- Carla Bouwmeester
- Northeastern University, Bouve College of Health Sciences School of Pharmacy, Boston, MA, USA.
| | | |
Collapse
|
18
|
Laborde CM, Mourino-Alvarez L, Akerstrom F, Padial LR, Vivanco F, Gil-Dones F, Barderas MG. Potential blood biomarkers for stroke. Expert Rev Proteomics 2013; 9:437-49. [PMID: 22967080 DOI: 10.1586/epr.12.33] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Stroke is one of the most common causes of death worldwide and a major cause of acquired disability in adults. Despite advances in research during the last decade, prevention and treatment strategies still suffer from significant limitations, and therefore new theoretical and technical approaches are required. Technological advances in the proteomic and metabolomic areas, during recent years, have permitted a more effective search for novel biomarkers and therapeutic targets that may allow for effective risk stratification and early diagnosis with subsequent rapid treatment. This review provides a comprehensive overview of the latest candidate proteins and metabolites proposed as new potential biomarkers in stroke.
Collapse
Affiliation(s)
- Carlos M Laborde
- Laboratory of Vascular Pathophysiology, Hospital Nacional de Paraplejicos, SESCAM, Toledo, Spain
| | | | | | | | | | | | | |
Collapse
|
19
|
Comparison of international normalized ratio measurement between CoaguChek XS Plus and STA-R coagulation analyzers. BIOMED RESEARCH INTERNATIONAL 2012; 2013:213109. [PMID: 23509691 PMCID: PMC3591144 DOI: 10.1155/2013/213109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/10/2012] [Indexed: 11/17/2022]
Abstract
Background. Point-of-care testing (POCT) coagulometers are increasingly being used in the hospital setting. We investigated whether the prothrombin time international normalized ratio (INR) results by CoaguChek XS Plus (Roche Diagnostics GmbH, Mannheim, Germany) can be used reliably without being confirmed with the INR results by STA-R system (Diagnostica Stago S.A.S, Asnières sur Seine, France). Methods. A total of 118 INR measurements by CoaguChek XS Plus and STA-R were compared using Passing/Bablok regression analysis and Bland-Altman plot. Agreement of the INR measurements was further assessed in relation to dosing decision. Results. The correlation of INR measurements between CoaguChek XS Plus and STA-R was excellent (correlation coefficient = 0.964). The mean difference tended to increase as INR results increased and was 0.25 INR in the therapeutic range (2.0-3.0 INR). The overall agreement was fair to good (kappa = 0.679), and 21/118 (17.8%) INR measurements showed a difference in dosing decision. Conclusion. The positive bias of CoaguChek XS Plus may be obvious even in the therapeutic INR range, and dosing decision based on the CoaguChek XS Plus INR results would be different from that based on the STA-R results. The INR measurements by POCT coagulometers still need to be confirmed with the laboratory INR measurements.
Collapse
|
20
|
Hashimoto VAM, De Paula EV, Colella MP, Luz Fiusa MM, Montalvao SAL, Machado TFGS, Orsi FA, Annichino-Bizzacchi JM. Performance of a point-of-care device in determining prothrombin time in supra-therapeutic INRs. Int J Lab Hematol 2012; 35:211-6. [DOI: 10.1111/ijlh.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/25/2012] [Indexed: 11/26/2022]
Affiliation(s)
- V. A. M. Hashimoto
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
| | - E. V. De Paula
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
- Department of Clinical Pathology; Faculty of Medical Sciences; Rua Alexander Fleming; University of Campinas; Campinas SP Brazil
| | - M. P. Colella
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
| | - M. M. Luz Fiusa
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
| | - S. A. L. Montalvao
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
| | - T. F. G. S. Machado
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
| | - F. A. Orsi
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
| | - J. M. Annichino-Bizzacchi
- Hematology and Hemotherapy Center; University of Campinas; Campinas SP Brazil
- Department of Clinical Pathology; Faculty of Medical Sciences; Rua Alexander Fleming; University of Campinas; Campinas SP Brazil
| |
Collapse
|