Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.
Acta Neurol Scand. 2018 Feb;137(2):252-255. doi: 10.1111/ane.12860. Epub 2017 Oct 25.
Effective anticoagulant therapy is a contraindication to thrombolysis, which is an effective treatment of ischemic stroke if given within 4.5 hours of symptom onset. INR above 1.7 is generally considered a contraindication for thrombolysis. Rapid measurement of INR in warfarin-treated patients is therefore of major importance in order to be able to decide on thrombolysis or not. We asked whether INR measured on a point-of-care instrument would be as good as a central laboratory instrument.
A total of 529 consecutive patients who arrived at the emergency department at a large urban teaching hospital with stroke symptoms were enrolled in the study. INR was measured with a CoaguChek and a Sysmex instrument. Basic clinical information such as age, sex, and diagnosis (if available) was recorded. INR from the instruments was compared using linear regression and Bland-Altman plot.
Of 529 patients, 459 had INR results from both instruments. Among these, 3 patients were excluded as outliers. The rest (n = 456) showed good correlation between the methods (R = 0.97). In the current setting, CoaguChek was in median 63 minutes faster than Sysmex.
Our results indicate that point-of-care testing is a safe mean to rapidly acquire a patient's INR value in acute clinical situations.
有效的抗凝治疗是溶栓的禁忌证，而溶栓是治疗发病 4.5 小时内缺血性脑卒中的有效方法。INR 超过 1.7 一般被认为是溶栓的禁忌证。因此，在华法林治疗的患者中快速测量 INR 对于决定是否进行溶栓治疗至关重要。我们想知道即时检测（point-of-care testing，POCT）的 INR 测量结果是否与中心实验室仪器的结果一样好。
共有 529 名连续出现脑卒中症状的患者在一所大型城市教学医院的急诊科入组本研究。INR 使用 CoaguChek 和 Sysmex 仪器进行测量。记录了基本的临床信息，如年龄、性别和诊断（如果有）。使用线性回归和 Bland-Altman 图比较仪器的 INR。
在 529 名患者中，有 459 名患者的两种仪器均有 INR 结果。其中 3 名患者的结果因离群值而被排除。其余 456 名患者（n=456）两种方法的相关性良好（R=0.97）。在当前的环境下，CoaguChek 比 Sysmex 平均快 63 分钟。
我们的结果表明，在急性临床情况下，即时检测是一种快速获得患者 INR 值的安全方法。
