Articles: prothrombin-time.
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Comparative Study
Self-monitoring of oral anticoagulation therapy in children.
This study aimed to investigate the accuracy of home International Normalized Ratio (INR) self-monitoring in pediatric patients on long-term oral anticoagulation therapy. Statistical and clinical agreement of INR values from capillary whole blood samples measured by 2 different portable prothrombin time monitors (CoaguChek S and XS) and venous blood samples measured by a laboratory coagulation analyzer were evaluated using the Bland-Altman analysis. Eighty-three INR comparisons (56 using the CoaguChek S and 27 using the CoaguChek XS) were obtained from 35 children aged 4 months to 18 years. ⋯ Expanded and narrow agreements for all patients were 97.6 and 94%, respectively. In conclusion, home INR self-monitoring is accurate for children requiring long-term oral anticoagulation therapy. Our data suggest that INR self-monitoring with the newer CoaguChek XS is more accurate than with the older CoaguChek S monitor.
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Several groups have reported that a fraction of severely injured patients have abnormal coagulation tests at presentation to trauma centers, even in the absence of significant crystalloid resuscitation. These patients have high mortality, but their prevalence in trauma populations is not clear from the reports. ⋯ Abnormal coagulation tests are common in severely injured patients. Even in the moderately injured, they are associated with higher mortality.
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Annals of hematology · Nov 2008
Feasibility, cost-effectiveness and patients' acceptance of point-of-care INR testing in a hospital-based anticoagulation clinic.
Point-of-care (POC) coagulometers are increasingly used by patients for self-monitoring of oral vitamin K antagonists therapy. We studied the feasibility of introducing POC international normalised ratio (INR) testing in place of standard laboratory assays in a hospital-based anticoagulation clinic with 250 active patients. The CoaguChek XS system was first validated in 253 INR samples and found to have a correlation of r = 0.945 with standard assays. ⋯ Among 232 respondents surveyed, 87.5% (95% CI 82.5-91.5%) preferred POC INR monitoring. Rates of thrombosis and major bleeding complications were 1.2% (95% CI 0.2-3.5%) and 0.4% (95% CI 0.01-2.2%), respectively. In conclusion, provided mechanisms are in place to address increased variations of INR at higher ranges, POC testing can be successfully implemented in busy hospital-based anticoagulation clinics.
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Semin. Thromb. Hemost. · Oct 2008
ReviewStandardization and clinical utility of thrombin-generation assays.
Thrombin generation is a key process that determines the extent of a hemostatic plug or a thrombotic process. The ensuing thrombin burst is crucial for the formation of a stable fibrin clot. During its active life, thrombin exerts a multitude of highly regulated actions on the blood and the vessel wall, including the clotting of fibrinogen. ⋯ Thrombin-generation assays not only provide an overall assessment of hemostasis but also target potential extrahemostatic effects of the generated thrombin, a potent agonist of a multitude of cellular activation pathways. Moreover, estimation of an individual's thrombin-generation potential may correlate more closely with a hypercoagulable or hypocoagulable phenotype when compared with traditional coagulation tests. In this review, we discuss to what extent thrombin generation can be expected to reflect the clotting function of blood, the development and use of different thrombin-generation assay systems suitable for detecting changes in the kinetics of thrombin generation, and the clinical utility of thrombin generation.