Comparison of international normalized ratio determined by point-of-care to standard laboratory testing before and after reversal of heparin in cardiac surgery.
Blood Coagul Fibrinolysis
; 31(2): 140-144, 2020 Mar.
Article
in En
| MEDLINE
| ID: mdl-31934886
ABSTRACT
STUDY OBJECTIVE:
To compare point-of-care (POC) of international normalized ratio to laboratory-derived values before and after cardiopulmonary bypass, with the primary aim of evaluating for any change in the relationship between the tests.METHODS:
This is a prospective observational study with 50 patients undergoing cardiac surgery enrolled. The International normalized ratio measured at two time points, precardiopulmonary bypass and after heparin reversal with protamine using both POC i-STAT and standard laboratory analysis for both time points. A difference of 0.2 between tests at either time point was considered clinically significant based on previous literature. A paired t test was used to test for a changing or statistically significant mean difference between tests. At both time points values were categorized into absolute difference of more than 0.2 or less than 0.2, and a Fisher's exact test was used to determine if an association existed between heparin reversal and a difference more than 0.2. Bland-Altman plots were also evaluated for agreement.RESULTS:
A statistically and clinically significant mean difference [0.09 vs. 0.25, difference -0.163 95% confidence interval (-0.25, -0.08), Pâ=â0.003] was seen between the laboratory and POC tests when pre and postheparin reversal samples were compared. A significantly greater number of patients had a clinically relevant difference between the tests post compared with pre (four patients vs. 18 patients, Pâ=â0.001). Linear regression analysis of the difference compared with the means, showed significant correlation suggesting the presence of a proportional bias (pre râ=â0.488, Pâ=â<0.01, post râ=â0.571, Pâ=â<0.01).CONCLUSION:
Clinically significant differences exist between POC and laboratory testing of international normalized ratio after heparin reversal during cardiac surgery. ClinicalTrials.gov Identifier NCT03267823.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Point-of-Care Systems
/
Clinical Laboratory Techniques
/
International Normalized Ratio
/
Cardiac Surgical Procedures
/
Heparin Antagonists
Type of study:
Diagnostic_studies
/
Observational_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Blood Coagul Fibrinolysis
Journal subject:
ANGIOLOGIA
/
HEMATOLOGIA
Year:
2020
Document type:
Article