• Theresa L Green, Adnan Mansoor, Nancy Newcommon, Caroline Stephenson, Eileen Stewart, and Michael D Hill.
• Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm C1101A, 1403-29th Street NW, Calgary, Alberta T2N 2T9, Canada.
• Can J Neurol Sci. 2008 Jul 1;35(3):348-51.

BackgroundIn the emergency department, portable point-of-care testing (POCT) coagulation devices may facilitate stroke patient care by providing rapid International Normalized Ratio (INR) measurement. The objective of this study was to evaluate the reliability, validity, and impact on clinical decision-making of a POCT device for INR testing in the setting of acute ischemic stroke (AIS).MethodsA total of 150 patients (50 healthy volunteers, 51 anticoagulated patients, 49 AIS patients) were assessed in a tertiary care facility. The INR's were measured using the Roche Coaguchek S and the standard laboratory technique.ResultsThe interclass correlation coefficient and 95% confidence interval between overall POCT device and standard laboratory value INRs was high (0.932 (0.69 - 0.78). In the AIS group alone, the correlation coefficient and 95% CI was also high 0.937 (0.59 - 0.74) and diagnostic accuracy of the POCT device was 94%.ConclusionsWhen used by a trained health professional in the emergency department to assess INR in acute ischemic stroke patients, the CoaguChek S is reliable and provides rapid results. However, as concordance with laboratory INR values decreases with higher INR values, it is recommended that with CoaguChek S INRs in the > 1.5 range, a standard laboratory measurement be used to confirm the results.

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