Near-patient testing Prothrombin time

patient testing microinr iline microsystems



a roche coaguchek xs.

in typical npt set up, small table-top device used. drop of capillary blood obtained automated finger-prick, painless. drop placed on disposable test strip machine has been prepared. resulting inr comes on display few seconds later. similar form of testing used people diabetes monitoring blood sugar levels, taught , routinely practiced.

local policy determines whether patient or coagulation specialist (pharmacist, nurse, general practitioner or hospital doctor) interprets result , determines dose of medication. in germany , austria, patients may adjust medication dose themselves, while in uk , usa remains in hands of health care professional.

a significant advantage of home testing evidence patient self-testing medical support , patient self-management (where patients adjust own anticoagulant dose) improves anticoagulant control. meta analysis reviewed 14 trials showed home testing led reduced incidence of complications (bleeding , thrombosis) , improved time in therapeutic range, indirect measure of anticoagulant control.

other advantages of npt approach fast , convenient, less painful, , offers, in home use, ability patients measure own inrs when required. among problems quite steady hand needed deliver blood exact spot, patients find finger-pricking difficult, , cost of test strips must taken account. in uk these available on prescription elderly , unwaged people not pay them , others pay standard prescription charge, @ moment represents 20% of retail price of strips. in usa, npt in home reimbursed medicare patients mechanical heart valves, while private insurers may cover other indications. medicare covering home testing patients chronic atrial fibrillation. home testing requires doctor s prescription , meter , supplies obtained medicare approved independent diagnostic testing facility (idtf).

there evidence suggest npt may less accurate patients, example have lupus anticoagulant.

guidelines

international guidelines published in 2005 govern home monitoring of oral anticoagulation international self-monitoring association oral anticoagulation. international guidelines study stated, consensus agrees patient self-testing , patient self-management effective methods of monitoring oral anticoagulation therapy, providing outcomes @ least as, , possibly better than, achieved anticoagulation clinic. patients must appropriately selected , trained. available self-testing/self-management devices give inr results comparable obtained in laboratory testing.

medicare coverage home testing of inr has been expanded in order allow more people access home testing of inr in usa. release on 19 march 2008 said, [t]he centers medicare & medicaid services (cms) expanded medicare coverage home blood testing of prothrombin time (pt) international normalized ratio (inr) include beneficiaries using drug warfarin, anticoagulant (blood thinner) medication, chronic atrial fibrillation or venous thromboembolism. in addition, [t]hose medicare beneficiaries , physicians managing conditions related chronic atrial fibrillation or venous thromboembolism benefit through use of home test.