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Point-of-care coagulation monitors calibrated for the international normalized ratio for cirrhosis (INRliver) can help to implement the INRliver for the calculation of the MELD score.
Point-of-care coagulation monitors calibrated for the international normalized ratio for cirrhosis (INRliver) can help to implement the INRliver for the calculation of the MELD score.
- Source :
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Journal of hepatology [J Hepatol] 2009 Aug; Vol. 51 (2), pp. 288-95. Date of Electronic Publication: 2009 May 20. - Publication Year :
- 2009
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Abstract
- Background/aims: The MELD defines a score used to prioritize patients awaiting liver transplantation and includes results for bilirubin, creatinine and PT expressed as INR. It is assumed that the MELD for individual patients is the same regardless of the laboratory method used for testing, thus ensuring parity of organ allocation. Previous studies showed that the INR calibrated for patients on vitamin K antagonists (INR(vka)) does not normalize results across thromboplastins, whereas an alternative calibration called INR(liver) does. However, implementation of INR(liver) calibration for thromboplastins is difficult in practice. This study aimed to assess whether easy-to-run whole-blood coagulation monitors (widely used for patients on VKA) can be calibrated to measure efficiently the INR(liver) and minimize the interlaboratory variability.<br />Methods: PT values for 61 cirrhotic patients were measured on native-blood with 2 monitors calibrated in terms of INR(vka). PTs for these subjects were also measured with a WHO-standard for thromboplastin. Paired-PTs with the monitors and the standard were subsequently used to calibrate the monitors in terms of INR(liver). INR(vka) and INR(liver) were then compared to assess for statistical significance.<br />Results: The mean INR(vka) obtained with the monitors and the standard were significantly different (p<0.001). Conversely, the corresponding INR(liver) were not.<br />Conclusions: The INR(liver) calibration as previously described for thromboplastins works also for the easy-to-run whole-blood coagulation monitors. Once the monitors are calibrated by the manufacturer in terms of INR(liver) they could be used as near-patient-testing devices directly by the personnel of liver units making the determination of the INR for patients awaiting liver transplantation much easier and standardized.
- Subjects :
- Adult
Aged
Aged, 80 and over
Case-Control Studies
Female
Humans
Liver Cirrhosis drug therapy
Liver Cirrhosis surgery
Liver Transplantation
Male
Middle Aged
Prognosis
Vitamin K antagonists & inhibitors
Young Adult
International Normalized Ratio standards
International Normalized Ratio statistics & numerical data
Liver Cirrhosis blood
Point-of-Care Systems standards
Point-of-Care Systems statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1600-0641
- Volume :
- 51
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 19501423
- Full Text :
- https://doi.org/10.1016/j.jhep.2009.04.014