SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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HR. Schmid1 , U. Fricker1 , G. Ilg-Frei1 , JH. Beer2

1Central Laboratory, Kantonsspital Baden, 2Departement of Medicine, Kantonsspital Baden

Objectives
The problem of different methods for PT determination is known as results also depend on the factor sensivity of the thromboplastin used. Therefore, the INR concept was introduced two decades ago (WHO). Still, changing of methods for PT determination is a possible pitfall in oral anticoagulation therapy (OAT). OAT monitoring is often performed by patient self-monitoring at home, by the family doctor and finally by hospital laboratory, whereby each INR value is often based on different methods. Citrated plasma based PT/INR methods have extensively been compared. Data on comparison of capillary blood based methods is not as abundant.
To estimate the correspondence between two different capillary blood based methods, we measured simultaneously PT and INR of patients as well on the Coagucheck PRO [COAG-PRO] as on the Coagucheck S [COAG-S] (Roche Diagnostics AG, Schweiz).
Methods
148 Patients visiting the central laboratory for capillary blood INR determination during 12-2001 and 02-2002 agreed on simultaneous determination of PT% and INR by COAG-PRO and COAG-S. One small incision at the finger-tip was normally sufficient for both determinations. COAG-PRO and COAG-S were used as instructed. COAG-S were compared to COAG-PRO values.
Results
Maximal differences of absolute INR-values between COAG-PRO and -S were –2.1 and +3.2. 25/148 (17%) results differ more than 0.5 INR-Units, 7/148 (5%) results differ more than 1 INR-Unit. INR Linear Regression is COAG-S = 0.8952 x COAG-PRO + 0.1251, with R=0.9034.
Conclusion
Bleeding because of derailed OAT is not a rare cause for hospital admittance. Discrepancy of INR results could be a cause for hospital admittance. In 17% of the cases, we found a discrepancy of greater than 0.5INR-Units, in 5% of the cases we even found a discrepancy of >1INR which could lead to a (wrong?) change in drug dosage for oral anticoagulation. Further efforts have to be made for enhancing the quality of capillary blood based PT methods.

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