ED POCT Test Menu and INR
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Hello All,
I have a request from our ED to look into INR testing using the iSTAT. Does anyone use this in their ED, if so what patient populations are cleared to use it at your facility? Also, what is the current menu of tests available to your ED? Please let me know. Any information is appreciated.
Thank you,
Max
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Hi Max,
We are using iSTAT PT/INR in our Surgery Plus and GI Center. You have to ask your ED Department what do they need it for because the iSTAT PT/INR is not for screening coagulopathy. It is only used for warfarin or coumadin monitoring. Hope that helps.
Hi Max, the i-STAT PT/INR intended use is only for coumadin monitoring. It it used at the health system I have POCT oversight of in the PACU (pre-anesthesia unit) to check Coumadin patient INR's prior to surgery, and in the ED for stroke protocol prior to TPA push to ensure the patient doesn't have a therapeutic anticoagulated INR. That's a grey area for the intended use but the justification is patient safety. The test is not used in lieu of the the Lab to speed TAT. My advice is to develop protocols for use of the test with the ED physician leadership to keep you out of compliance trouble and to prevent improper use on the wrong patient population. We did have the CHEM8+ in the ED but it was pulled due to the manufacturer recall.
Donna and Karen,
Thank you. I was thinking that the iSTAT INR could only be used for coagulation therapy monitoring. The ED wants to use this as a check before TPA push on stroke patient population; looking at the intended use I was thinking that was a no-go or would shift this to a high complexity test.
Karen,
Do you consider this now a high complexity test/LDT for your ED?
Hi Karen!
Can you tell me more about how they determine the patient is therapeutically anticoagulated? I know the INR will be elevated for a patient on Coumadin. But what about patients on NOACs (novel oral anticoagulants)? INR isn't the appropriate way to measure those patient's coag status, so will the INR be reliably elevated for the NOAC patients? Obviously the iSTAT INR will be wrong for patients in DIC or factor deficiencies and that is why we don't use it on everyone, but I have been asked a lot by the ED to use it for the purpose you are and just don't know what we would expect to see from a NOAC patient's INR. Do you have more info on that? I would appreciate the info!
Thank you,
Mary
You cannot use the i-STAT PT-INR to test any patients unless they are on Warfarin treatment. It can't be used for random checks on patients not known to be on therapy with Warfarin. We no longer do POCT INR in the ED, as we can't trust that they'll use it only on known Warfarin patients.
Does anyone have a POCT PT/INR instrument in their facility that is "intended for use with Stroke Alert patients"?
We were just recently asked to look into adding this to our facility. We originally thought- maybe the iSTAT, but after reviewing this discussion, it looks like it is only intended for monitoring patients on a known therapy with Warfarin or Coumadin. As is Coagu-ChekXS and Coagusense.
Are there any other instruments out there?
Thanks,
Kelly
The only POCT instrument that I am aware of for PT-INR on any patient is the IL Hemochron. You can use citrated whole blood to do the test, and it is mod complexity.