I-STAT, COAGUCHEK XS PLUS, AND HEMOCHRON VERSUS REFERENCE LABORATORY INRS: PHARMACIST-MANAGED CLINICS
Keywords:
I-Stat, CoaguChek-XS Plus, Hemochron, WarfarinAbstract
Objectives: The international normalized ratio (INR) is the primary measure used to determine the therapeutic effect of warfarin. I-Stat, CoaguChek-XS Plus, and Hemochron are the most frequently used point-of-care tests (POCTs); hence, we compared the results of each with our reference laboratory results.
Methods: Subjects were recruited during our clinic's annual evaluation phase for therapeutic optimization. Upon acceptance, an instant ï¬nger-stick or ï¬nger-prick test was performed as required in addition to venous blood sampling. Approximately 0.1–0.3 mL of blood was taken peripherally for the POCTs, whereas 3 mL was taken for the reference laboratory to measure the INR. Bland-Altman plots were used to analyze the data and test their agreement.
Results: A total of 180 blood samples were taken from 45 patients. The sample volumes for Hemochron were higher than for I-Stat and CoaguChek-XS Plus, and 70% of patients reported more pain for this method. While I-Stat has additional test options and does not require a ï¬nger stick, CoaguChek-XS Plus is the cheapest test in terms of the acquisition cost for the handset and strips. The INR estimated by the reference laboratory ranged from 1.1 to 8. The Bland-Altman plots revealed a good agreement between methods, with only 3–6 outliers in each plot. Of the samples, 6%, 6%, and 13% of the results were considered to be outside the clinically acceptable range (±0.5 INR) for I-Stat, CoaguChek-XS Plus, and Hemochron, respectively.
Conclusion: The results obtained using the three POCTs are in good agreement with the reference laboratory results.
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References
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