Point-of-care international normalized ratio testing is rapid and reliable: A prospective observational cohort study

Abstract

Background: International normalized ratio (INR) >1.5 may indicate need for reversal of coagulopathy or massive transfusion (MT) in trauma patients. Thus, obtaining INR values as early as possible would expedite both clinical decisions. This study evaluates the reliability of using a point-of-care (POC) device to obtain INR results more rapidly. Methods: A trained pharmacist used the CoaguChek® XS Plus (Roche Diagnostics, Basel, Switzerland) device to determine POC INRs in venous blood from adult (>18 years) trauma patients not transfused prior to arrival. POC and laboratory INR (lab INR) values and times to availability were compared. The POC INR value was not used for clinical treatment decisions. Results: POC INR was performed on 177 patients; 43 were excluded due to missing lab INR or later recognition of prehospital blood transfusion. The mean lab INR was 1.163, and the mean POC INR was 1.167. The paired samples correlation was 0.958 (P Conclusion: This study confirms that POC INR is a rapid, reliable tool to detect patients who may need prompt reversal of anticoagulant medications or initiation of MT. The following core competencies are addressed in this article: Patient care, Medical knowledge, Systems based practice