RESUMEN
INTRODUCTION: Therapy with Vitamin K antagonists (VKA) is effective in reducing thromboembolic events in various diseases. There are limitations however, which limit clinical handling and maintaining INR within therapeutic range. Studies have shown that portable coagulometers, when compared to laboratory tests, are more practical and provide better patient adherence and involvement toward treatment which results in better INR control. This study aimed to evaluate laboratory obtained INR results compared to two different portable coagulometers. METHODS: A prospective study which monitored 1009 patients using VKA in the Anticoagulation Clinic at the Institute Dante Pazzanese of Cardiology in São Paulo between July and September 2012. Patient INR values were obtained by the laboratory through venipuncture and then compared to INR values obtained by capillary puncture from two different portable coagulometers. RESULTS: Overall, 1009 patients were included in the study; among these, 520 (51.5%) are male with average age of 59.6 years (13-91). The more common indications were atrial fibrillation (49.9%) and mechanical prosthesis (33.7%). The correlation coefficient was of 0.95 with and 0.88 with INRatio PT Monitor(®) compared to laboratory. In patients with INR < 2 (lower than therapeutic range), the coefficient was 0.92 and 0.81 for CoaguChek XS plus(®) and INRatio PT Monitor(®) respectively. In patients within therapeutic range (INR 2-3), the coefficient was 0.86 with CoaguChek XS Plus(®) and 0.76 with INRatio PT Monitor(®) . For INR above therapeutic range (INR > 3.0) the correlation was 0.80 with CoaguChek XS Plus(®) and 0.54 with INRatio PT Monitor(®) . As for concordance between methods, the intraclass correlation coefficients (ICC) were slightly smaller than those previously stated (ICC = 0.899 with CoaguChek XS Plus(®) and ICC = 0.716 with INRatio PT Monitor(®) ). CONCLUSION: The use of portable coagulometers was comparable to laboratory tests and better correlation coefficients were observed with CoaguChek XS Plus(®) and in patients with INR lower or within therapeutic range. Portable coagulometers proved to be a useful and reliable tool for INR control in patients using VKA.
Asunto(s)
Hematología/normas , Relación Normalizada Internacional/normas , Laboratorios , Tromboelastografía/normas , Tromboembolia/sangre , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Coagulación Sanguínea/efectos de los fármacos , Monitoreo de Drogas , Femenino , Hematología/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Estudios Prospectivos , Tromboelastografía/instrumentación , Tromboembolia/prevención & control , Warfarina/uso terapéuticoRESUMEN
Therapy with Vitamin K antagonists (VKA) is effectivein reducing thromboembolic events in various diseases. There arelimitations however, which limit clinical handling and maintainingINR within therapeutic range. Studies have shown that portable coagulometers,when compared to laboratory tests, are more practicaland provide better patient adherence and involvement towardtreatment which results in better INR control. This study aimed toevaluate laboratory obtained INR results compared to two differentportable coagulometers.Methods: A prospective study which monitored 1009 patients usingVKA in the Anticoagulation Clinic at the Institute Dante Pazzaneseof Cardiology in S~ao Paulo between July and September 2012.Patient INR values were obtained by the laboratory through venipunctureand then compared to INR values obtained by capillarypuncture from two different portable coagulometers.Results: Overall, 1009 patients were included in the study; amongthese, 520 (51.5%) are male with average age of 59.6 years (1391). The more common indications were atrial fibrillation (49.9%)and mechanical prosthesis (33.7%). The correlation coefficient wasof 0.95 with and 0.88 with INRatio PT Monitor compared to laboratory.In patients with INR 3.0) the correlation was 0.80 with CoaguChek XSPlus and 0.54 with INRatio PT Monitor ...