Is point-of-care accurate for indicating thrombolysis in anticoagulated patients on oral anticoagulation treatments?

• Published in: Arquivos de neuro-psiquiatria Vol. 72; no. 7; pp. 487 - 489
• Main Authors: Bruch, Tatiana P, Mendes, Danielle C, Pedrozo, Jeff C, Figueiredo, Lívia, Nóvak, Edison M, Zétola, Viviane F, Lange, Marcos C
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Academia Brasileira de Neurologia - ABNEURO 01.07.2014; Academia Brasileira de Neurologia (ABNEURO)
• Subjects: Aged; Anticoagulants - therapeutic use; anticoagulation; Brain Ischemia - drug therapy; Contraindications; Female; Humans; International Normalized Ratio - methods; International Normalized Ratio - standards; ischemic stroke; Male; Middle Aged; NEUROSCIENCES; Point-of-Care Systems - standards; PSYCHIATRY; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Statistics, Nonparametric; Stroke - drug therapy; Thrombolytic Therapy; warfarin; acidente vascular cerebral; varfarina; contraindications; terapia trombolítica; anticoagulação oral; anticoagulation; thrombolytic therapy; antagonistas da vitamina K; testes de coagulação sanguínea; ischemic stroke; warfarin
• ISSN: 0004-282X; 1678-4227; 1678-4227; 0004-282X
• DOI: 10.1590/0004-282X20140075

The use of oral anticoagulation treatment (OAT) in patients with an international normalized ratio (INR) higher than 1.7 is a contraindication to thrombolysis in acute ischemic stroke. The aim of the present study is to compare the use of point-of-care (POC) coagulometers to the standard coagulation analysis (SCA) procedure of the INR as a decision-making test for use with patients taking OAT. Eighty patients on chronic OAT underwent a POC and an SCA during a regular outpatient evaluation. When comparing the abilities of the POC test and the SCA test to identify adequate levels for thrombolysis (≤1.7), the POC had a sensitivity of 96.6% (95%CI 88.4-99.1) and a specificity of 60.0% (95%CI 38.6-78). POC overestimated INR levels by 0.51 points compared to the SCA test. POC has a high sensitivity compared to the SCA test for the identification of patients within the cut-off point for thrombolysis.