Point-of-care and standard laboratory coagulation testing during cardiovascular surgery: Balancing reliability and timeliness

Objective. The use of point-of-care technology has increased faster than ef forts to validate its effectiveness compared to standard laboratory testing modalities. To address this issue with a current point-of-care coagulation system (HEMOCHRON(R) Jr, International Technidyne Corporation (ITC), Ediso n, NJ), we designed a study to test the hypothesis that data obtained from point-of-care coagulation equipment correlates with data obtained from stan dard laboratory coagulation equipment. One of the potential advantages gain ed using point-of-care testing is the ability to obtain more rapid results. To address this issue, turnaround time, defined as the elapsed time (in mi nutes) from when the sample was acquired from the patient until the investi gators knew the results, was also determined. Methods. Following Human Inve stigation Committee approval and informed consent, a prospective study was conducted to compare results obtained from point-of-care coagulation equipm ent with those results obtained from standard laboratory coagulation equipm ent. The study was performed in three groups of patients undergoing cardiov ascular surgery, each requiring different levels of anticoagulation. Result s. Of the 83 patients who met the inclusion criteria, the correlation (comb ining data from groups 1-3) between results obtained from point-of-care and standard laboratory prothrombin time was r = 0.867, p < 0.001. The correla tion (group 3) between point-of-care and standard laboratory international normalized ratio was r = 0.943, p < 0.001. The correlation (combining data from groups 1 & 2) between point-of-care and standard laboratory activated partial thromboplastin time was r = 0.825, p < 0.001. Median turnaround tim e for the standard laboratory was 90 minutes, with a mean turnaround time o f 74 to 78 minutes, depending upon the group. In contrast, the median turna round time for point-of-care testing was two minutes and 14 seconds. Conclu sions.The results from this study population reveal that data obtained from point-of-care prothrombin time, international normalized ratio and activat ed partial thromboplastin time results correlate with results obtained from standard laboratory coagulation testing. The value of obtaining reliable r esults in a timely fashion offers a potential advantage for point-of-care t esting in clinical situations, such as in the operating room, where saving time may translate into financial savings.