Point-of-care testing INR: an overview

2017 ◽  
Vol 55 (6) ◽  
pp. 800-805 ◽  
Author(s):  
Doris Barcellona ◽  
Lara Fenu ◽  
Francesco Marongiu
Keyword(s):  
Point Of Care ◽  
Cost Effective ◽  
International Normalized Ratio ◽  
Point Of Care Testing ◽  
Mechanical Valves ◽  
Self Testing ◽  
Periodic Monitoring ◽  
Monitoring Test ◽  
Pros And Cons

Abstract Oral anticoagulant therapies with the anti-vitamin K drugs (AVK), warfarin, acenocoumarol and phenprocoumon, are employed in primary and secondary anti-thrombotic prophylaxis in patients with venous thromboembolism, atrial fibrillation and cardiac mechanical valves. However, a monitoring test such as the International Normalized Ratio (INR) is required. The periodic monitoring of this therapy entails discomfort for the patients. Telemedicine and telecare can provide significant aid in the management of this therapy allowing patients to perform the test at home or anywhere else with a portable device, i.e. point-of-care testing (POCT), and to send the result to a thrombosis (TC) via web. Patients can receive dose adjustment sent back by the TC. The effectiveness of this type of management is equal or superior to the traditional AVK monitoring in terms of hemorrhagic and thrombotic events. Analysis of the costs with a horizon of 10 years reveals that both self-testing and self-management are cost-effective. The aim of this overview is to describe the pros and cons of the use of POCT as an alternative in the monitoring of AVK. In particular, description of the POCT, decentralization, quality of the therapy, safety and costs will be examined.

scholarly journals Point-of-Care Testing of International Normalized Ratios for People on Oral Anticoagulants: A Rapid Qualitative Review

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Elijah Herington ◽  
Danielle MacDougall
Keyword(s):  
Point Of Care ◽  
Oral Anticoagulants ◽  
Community Pharmacists ◽  
International Normalized Ratio ◽  
Health Needs ◽  
Point Of Care Testing ◽  
Anticoagulation Management ◽  
Personalized Care ◽  
Ongoing Training ◽  
Self Testing

The opportunity to engage in self-testing can be experienced as simultaneously liberating and constraining. While self-testing may be appreciated as a form of point-of-care testing for international normalized ratio (INR) levels, some people engaged in self-testing were concerned with the limited amount of personalized care they received. People using oral anticoagulants described community pharmacist-led anticoagulation management services (CPAMS) as a convenient way of testing INR levels and learning about their health needs. Community pharmacists felt they were well-situated to provide care through CPAMS, but acknowledged the importance of ongoing training, oversight, and appropriate levels of resourcing.

The Value of a Specialized Program for the Management of Oral Anticoagulation

1997 ◽  
Vol 17 (03) ◽  
pp. 133-136 ◽  
Author(s):  
Jack Ansell
Keyword(s):  
United States ◽  
Oral Anticoagulation ◽  
New Technologies ◽  
Point Of Care ◽  
Cost Effective ◽  
International Normalized Ratio ◽  
The United States ◽  
Self Management ◽  
Anticoagulation Management ◽  
Self Testing

SummaryOral anticoagulation has proven to be an effective and useful therapy for over 50 years for patients at risk for thromboembolism, but recent evidence suggests that many patients are not only poorly managed, but therapy is withheld from a significant number of individuals because of the fear of complications and the labor intensiveness of treatment.Over the last decade several developments have occurred that may increase and improve the use of oral anticoagulation by effectively lowering the risk/benefit profile. Among these have been the standardization of the prothrombin time using the International Normalized Ratio leading to more appropriate and standardized therapy, and a number of consensus conferences in the United States and throughout the world focusing on indications for anticoagulation. Less has occurred in a coordinated fashion to substantially improve the management of oral anticoagulation until very recently. There is now accumulating evidence showing that a coordinated and focused approach to the management of therapy by specialized programs significantly improves clinical outcomes by improving therapeutic control, lessening the frequency of hemorrhage or thrombosis and decreasing the use of medical resources leading to more cost-effective therapy. Furthermore, with the development of new technologies for the measurement of prothrombin times (capillary whole blood PTs or point-of-care testing) allows for novel models of management including patient self-testing and patient self-management. These latter concepts are beginning to be popularized in several regions, especially Germany, Canada and the United States.The focus of the presentation will be to comment on the barriers to more effective and widespread use of anticoagulation and to summarize advances in the management of therapy including the concept of anticoagulation management services, patient self-testing and patient self-management.

scholarly journals Quality assurance for HIV point-of-care testing and treatment monitoring assays

2016 ◽  
Vol 5 (2) ◽  
Author(s):  
Adrienne F.A. Meyers ◽  
Paul Sandstrom ◽  
Thomas N. Denny ◽  
Mackenzie Hurlston ◽  
Terry B. Ball ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Point Of Care ◽  
Scale Up ◽  
Cost Effective ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Antiretroviral Therapies ◽  
Laboratory Services ◽  
The Cost

In 2015, UNAIDS launched the 90-90-90 targets aimed at increasing the number of peopleinfected with HIV to become aware of their status, access antiretroviral therapies and ultimatelybe virally suppressed. To achieve these goals, countries may need to scale up point-of-care (POC) testing in addition to strengthening central laboratory services. While decentralisingtesting increases patient access to diagnostics, it presents many challenges with regard totraining and assuring the quality of tests and testing. To ensure synergies, the London Schoolof Hygiene & Tropical Medicine held a series of consultations with countries with an interestin quality assurance and their implementing partners, and agreed on an external qualityassessment (EQA) programme to ensure reliable results so that the results lead to the bestpossible care for HIV patients. As a result of the consultations, EQA International wasestablished, bringing together EQA providers and implementers to develop a strategic planfor countries to establish national POC EQA programmes and to estimate the cost of setting upand maintaining the programme. With the dramatic increase in the number of proficiencytesting panels required for thousands of POC testing sites across Africa, it is important tofacilitate technology transfer from global EQA providers to a network of regional EQA centresin Africa for regional proficiency testing panel production. EQA International will continue toidentify robust and cost-effective EQA technologies for quality POC testing, integrating noveltechnologies to support sustainable country-owned EQA programmes in Africa.

Paper-based point-of-care testing for cost-effective diagnosis of acute dengue infections

2016 ◽  
Vol 82 ◽  
pp. S51
Author(s):  
F. Bedin ◽  
E. Voilin ◽  
L. Boulet ◽  
G. Theillet ◽  
A. Perrin ◽  
...  
Keyword(s):  
Point Of Care ◽  
Cost Effective ◽  
Point Of Care Testing ◽  
Effective Diagnosis

Point-of-care testing, medical error, and patient safety: a 2007 assessment

2007 ◽  
Vol 45 (6) ◽  
Author(s):  
Sharon S. Ehrmeyer ◽  
Ronald H. Laessig
Keyword(s):  
Patient Safety ◽  
Full Advantage ◽  
Medical Error ◽  
Point Of Care ◽  
Data Interpretation ◽  
Medical Data ◽  
Test Results ◽  
Point Of Care Testing ◽  
Proper Design

AbstractPoint-of-care testing (POCT) is the fastest growing segment of a US$30 billion worldwide market. “Errors” in the testing process, as well as medical data interpretation and treatment associated with POCT, are recognized as leading to major compromises of patient safety. In today's environment, most testing errors (pre-analytical, analytical and post-analytical) can be virtually eliminated by proper design of testing systems. We cite examples of two systems that have made exceptional progress in this respect. It has been recently suggested that the basic errors associated with the testing process are amplified in the POC setting. Two of the amplifiers – incoherent regulations and failure of clinician/caregivers to respond appropriately to POCT results – lead us to recognize additional changes in today's POCT environment. The first is a willingness of manufacturers, not laboratories, to take responsibility for the quality of test results – an outgrowth of an industrial philosophy called autonomation. The second is a need to substantially modify the clinician/caregiver test utilization paradigm to take full advantage of POCT results, available on site in real time. Both have already begun to take place.Clin Chem Lab Med 2007;45:766–73.

scholarly journals Point-of-care coagulation testing for reducing in-hospital delay in thrombolysis

2018 ◽  
Vol 26 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Jung Hee Han ◽  
Seongsoo Jang ◽  
Mi-Ok Choi ◽  
Mi-Jeong Yoon ◽  
Seung-Bok Lim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Prothrombin Time ◽  
Laboratory Testing ◽  
Point Of Care ◽  
Intravenous Thrombolysis ◽  
International Normalized Ratio ◽  
Interquartile Range ◽  
Time Interval ◽  
Central Laboratory ◽  
Point Of Care Testing

Background: The confirmation of prothrombin time international normalized ratio by a central laboratory often delays intravenous thrombolysis in patients with acute ischemic stroke. Objectives: We investigated the feasibility, reliability, and usefulness of point-of-care determination of prothrombin time international normalized ratio for stroke thrombolysis. Methods: Among 312 patients with ischemic stroke, 202 who arrived at the emergency room within 4.5 h of stroke onset were enrolled in the study. Patients with lost orders for point-of-care testing for the prothrombin time international normalized ratio or central laboratory testing for the prothrombin time international normalized ratio (n = 47) were excluded. We compared international normalized ratio values and the time interval from arrival to the report of test results (door-to-international normalized ratio time) between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio. In patients who underwent thrombolysis, we compared the time interval from arrival to thrombolysis (door-to-needle time) between the current study population and historic cohort at our center. Results: In the 155 patients included in the study, the median door-to-international normalized ratio time was 9.0 min (interquartile range, 5.0–12.0 min) for point-of-care testing for the prothrombin time international normalized ratio and 46.0 min (interquartile range, 38.0–55.0 min) for central laboratory testing for the prothrombin time international normalized ratio (p < 0.001). The intraclass correlation coefficient between point-of-care testing for the prothrombin time international normalized ratio and central laboratory testing for the prothrombin time international normalized ratio was 0.975 (95% confidence interval: 0.966–0.982). Forty-nine of the 155 patients underwent intravenous thrombolysis. The door-to-needle time was significantly decreased after implementation of point-of-care testing for the prothrombin time international normalized ratio (median, 23.0 min; interquartile range, 16.0–29.8 vs median, 46.0 min; interquartile range, 33.5–50.5 min). Conclusion: Utilization of point-of-care testing for the prothrombin time international normalized ratio was feasible in the management of patients with acute ischemic stroke. Point-of-care testing for the prothrombin time international normalized ratio was quick and reliable and had a pivotal role in expediting thrombolysis.

scholarly journals Three-Dimensional Paper-Based Microfluidic Analysis Device for Simultaneous Detection of Multiple Biomarkers with a Smartphone

Biosensors ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 187
Author(s):  
Seung Ho Baek ◽  
Chanyong Park ◽  
Jaehyung Jeon ◽  
Sungsu Park
Keyword(s):  
Point Of Care ◽  
Simultaneous Detection ◽  
Three Dimensional ◽  
Cost Effective ◽  
Smartphone Application ◽  
Accurate Diagnosis ◽  
Point Of Care Testing ◽  
Digital Light Processing ◽  
Multiple Biomarkers ◽  
Microfluidic Analysis

Paper-based microfluidic analysis devices (μPADs) have attracted attention as a cost-effective platform for point-of-care testing (POCT), food safety, and environmental monitoring. Recently, three-dimensional (3D)-μPADs have been developed to improve the performance of μPADs. For accurate diagnosis of diseases, however, 3D-μPADs need to be developed to simultaneously detect multiple biomarkers. Here, we report a 3D-μPADs platform for the detection of multiple biomarkers that can be analyzed and diagnosed with a smartphone. The 3D-μPADs were fabricated using a 3D digital light processing printer and consisted of a sample reservoir (300 µL) connected to 24 detection zones (of 4 mm in diameter) through eight microchannels (of 2 mm in width). With the smartphone application, eight different biomarkers related to various diseases were detectable in concentrations ranging from normal to abnormal conditions: glucose (0–20 mmol/L), cholesterol (0–10 mmol/L), albumin (0–7 g/dL), alkaline phosphatase (0–800 U/L), creatinine (0–500 µmol/L), aspartate aminotransferase (0–800 U/L), alanine aminotransferase (0–1000 U/L), and urea nitrogen (0–7.2 mmol/L). These results suggest that 3D-µPADs can be used as a POCT platform for simultaneous detection of multiple biomarkers.

scholarly journals Analysis: Investigating the quality of POCT devices for HbA1c, what are our next steps?

2019 ◽  
Vol 13 (6) ◽  
pp. 1154-1157 ◽  
Author(s):  
Erna Lenters-Westra ◽  
Emma English
Keyword(s):  
Point Of Care ◽  
Performance Evaluations ◽  
Clinical Settings ◽  
Point Of Care Testing ◽  
Performance History ◽  
Future Studies ◽  
Wide Range ◽  
Need To Evaluate ◽  
Number Of Publications

There are a growing number of publications evaluating the performance of HbA1c point-of-care testing (POCT) devices when compared to routine laboratory instruments, but is this what we need from future studies? Here we describe the current understanding of the performance of POCT for HbA1c, which areas need further studies, and the key requirements for future publications based on performance evaluations of these devices. These include studies in clinical settings, performance measured against internationally standardized reference methods, and the need to evaluate new to the market devices that do not currently have a detailed performance history. In addition we highlight the need for external quality assessment schemes that are designed to support POCT in a wide range of clinical settings.

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