International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 Volume 6 Issue 8, August 2017 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Comparison of Point of Care Device with Lab Monitoring of INR Assay for Monitoring of Anticoagulant Therapy Dr. Prashant Kumar Singh 1 , Dr. Smriti Rathore 2 , Dr. Anil Vatwani 3 1 Registrar, Indraprastha Apollo Hospital, New Delhi 2 Consultant Pathology, Valencia Hospital, Faridabad 3 Cardiologist, INHS Kalyani, Vishakhapatnam Abstract: Objective : To test whether point of care measurement is as safe, as lab measurement of patient as assessed by therapeutic international normalized ratio(INR) control. Methods :It is a hospital based prospective comparative study, including 80 patients, dividing into group 1, in which INR was measured with the help of point of care device at OPD and in group 2, in which INR was measured by standard lab and accordingly dose adjustments were done monthly and were followed up for 6 months. Results : The incidence of major bleed was 5% in group 2 and no major bleeding events in group 1. The incidence of thromboembolic events was equal in both groups which was 5% in each group. The incidence of major events was 5% and 10% patient year respectively in group 1 and 2. The incidence of minor bleeding events was 20% and 10% respectively in group 1 and 2.Overall incidence of adverse event was 25% and 20% respectively in group 1 and 2. Percentage of time in therapeutic range which can be considered as surrogate marker for clinical effectiveness of INR control for propensity of adverse event is significantly more in group 1(59.59%) than group 2(48.95%). Conclusion : INR measurement with point of care device for monitoring of oral anticoagulant therapy is as safe, as lab measurement by therapeutic international normalized ratio(INR) control. Keywords: Point of care(POC), International normalized ratio(INR) 1. Introduction Oral anticoagulation therapy with vitamin K antagonist(VKA) has been shown reduce thromboembolic events in multiple clinical contexts. [1, 2] These include atrial fibrillation, treatment of deep-vein thrombosis, prosthetic heart valves, and acute myocardial infarction. Oral anticoagulation(OAC) with warfarin or other Vitamin K Antagonist(VKA) like Acenocumarole or Phenprocoumon could potentially prevent more than half of the strokes related to atrial fibrillation and heart valve replacements with a relatively low risk of major bleeding complications. [3] However, much of this potential is still not obtained because of under and suboptimal use. [4] The number of patients receiving OAC drugs has been constantly increasing during the last decade. Reasons include improvements in clinical outcomes, increasing common disease indications for their use, and improvements in anticoagulant safety. [5, 6, 7] Due to the complex pharmacokinetics of warfarin, continuous monitoring and dose adjustments are required. [8] VKA treatment requires regular monitoring of prothrombin time (PT) with dose-adjustment by a specialized hospital service, primary care physician, registered nurse, nurse practitioner, or pharmacist [9, 10]. Current models of oral anticoagulation management include the traditional hospital outpatient model which include laboratory testing of International Normalized Ratio (INR) coupled with VKA dosage adjustment by a physician or through an anticoagulation clinic and various forms of community-based models, all requiring patient attendance at a clinic. [11] The introduction of portable monitors(point-of-care devices) allows the patient to self-test at home or clinic with a drop of whole blood. Self-management of VKA by the patient is an evolving model whereby trained patients can test their INR using point of care (POC) systems and adjust their OAC dosages. [12] POC coagulation testing has been termed the most rapidly growing point of care application in the hospital setting. This rapid growth implies a widespread acceptance of the use of point of care coagulation assays, yet it is unclear whether documentation exists showing a clinical advantage to these methodologies. [13] 2. Material and Methods Aim To test whether POC measurement is as safe, in terms of clinical effectiveness, as lab measurement of patient as assessed by therapeutic INR control in patients on oral anticoagulation. Source of Data The patients attending cardiology clinic and medical department of a tertiary care hospital who were on oral anticoagulant therapy (OAT) for various indications were included in this study. Study Design Prospective comparative study. Paper ID: ART20176386 DOI: 10.21275/ART20176386 1801