Comparison of Point-of-Care Activated Clotting Time Systems Utilized in a Single Pediatric Institution

Abstract

This study compares four different activated clotting time (ACT) point-of-care (POC) testing systems used at our institution for the management of patients undergoing heparin therapy. We evaluated these systems under identical conditions to determine their accuracy, reproducibility, ease of use, and cost. Two separate testing stations containing four ACT systems were used. The testing order was randomized for every sample and performed by two trained individuals. Samples of fresh heparinized whole blood were taken at regular intervals and distributed to each station. Each operator tested 50 samples, totaling 400 ACT tests. The ACT value was significantly affected by the type of machine used at both stations 1 and 2 (p < .001). Compared with all systems, the Medtronic ACT Plus Automated Coagulation Timer System (ACT Plus) resulted in the most consistent ACT values (median = 171, Interquartile Range (IQR): 169–175) and least variability (172.17 ± 5.24). The Hemochron Signature Elite Whole Blood Microcoagulation System had the most variability (221.10 ± 14.78) and yielded consistently higher ACT values (median = 220, IQR: 210–229.5) compared with other systems. The ACT values reported by the i-STAT Handheld and Test Cartridge Blood Analysis System (153.30 ± 7.87) were consistently lower (median = 154, IQR: 147–161) in comparison to the ACT Plus and Medtronic HMS Plus Hemostasis Management System (180.60 ± 7.60, median = 181, IQR: 175–186). There was no statistical difference in results between the two testing sites (p > .05) or the operators (p >.05). The significant finding of this study was the affect each system has on the ACT value. This investigation demonstrates the variability that exists among different ACT monitoring systems at our institution. The discrepant variation in ACT values that exists with the Hemochron system questions the reliability of its use in the management of patients undergoing heparin therapy.