Abstract Number: PB2460
Meeting: ISTH 2020 Congress
Background: An improvement in the time within the therapeutic range (TTR) was obtained by monitoring the international normalised ratio (INR) by patients themselves with point-of-care (POC) devices. However, the use of POC in anticoagulation clinics was recently reported to be associated with significantly lower TTR than the standard laboratory INR.
Aims: To compare the TTR between laboratory and POC INR monitoring, both performed by healthcare professionals.
Methods: Retrospective review of consecutive adult patients on warfarin treatment attending the POC INR Anticoagulation Clinics at 7 Health Centres in Malta in the years 2014-2015, and prescribed with INR target ranges 2.0-3.0 or 2.5-3.5. For each patient, 3 timeframes were considered: 1) the last year of standard laboratory INR monitoring (pre-POC); 2) the first year of POC INR monitoring (initial-POC); 3) the results of year 2017 (stable-POC).
Results: 700 patients were analysed (median age 70 years, 56.6% males). Most common indications for warfarin were atrial fibrillation (72.4%), mechanical heart valve (15.6%), venous thromboembolism (12.6%). The analysis of the three timeframes included 471 patients and showed a significant increase of the median TTR (70.0% in the pre-POC period, 74.2% in the initial-POC, 77.2% in the stable-POC, p< 0.001). The median INR difference was 5.1% (95% CI, 2.2-7.0%) for time 2 vs. time 1; 6.6% (95% CI, 3.7-8.9%) for time 3 vs. time 1; 2% (95% CI, 0-3.4%) for time 3 vs. time 2. There was also a significant increase in the number of days between two INR tests (p< 0.001).
Conclusions: The use of POC devices in anticoagulation clinics was associated with 5.1% increase of the TTR in the short term (initial-POC) and 6.6% increase in the long term (stable-POC), compared to the standard laboratory INR monitoring. Our findings suggest that the immediate availability of INR results and consequent dose adjustment is associated with better anticoagulation control.
To cite this abstract in AMA style:Riva N, Meli S, Borg Xuereb C, Ageno W, Makris M, Gatt A. Anticoagulation Control with the Point-of-Care INR: A Retrospective Pre-/Post-analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/anticoagulation-control-with-the-point-of-care-inr-a-retrospective-pre-post-analysis/. Accessed January 23, 2022.
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