![]() ![]() Furthermore, our data question the reliability of the Hemochron in assessing adequacy of heparin anticoagulation monitoring for CPB.ĪCT Activated clotting time Anticoagulation Cardiopulmonary bypass Heparin Method comparison Protamine. Methods: We performed parallel testing of the ACCRIVA Hemochron Signature Elite ACT+ and Hemochron Response analyzer, iSTAT platform, and 2 Hepcon Hemostasis Management System (HMS) Plus analyzers for monitoring intraoperative heparin treatment. ![]() Furthermore, while discrepancies in ACT between two parallel iSTAT assays showed little or no clinical relevance, deviations from parallel Hemochron assays and iSTAT versus Hemochron measurements revealed marked and sometimes clinically critical deviations.Ĭurrently used ACT point-of-care devices cannot be used interchangeably. Overall, disconcordant results according to clinically predefined target values were more frequent with the Hemochron than i-STAT. Although demonstrating a fair linear correlation (r = 0.815), parallel measurements on different ACT-devices showed large bias (-20s 95% LOA: - 290-250 s) and little concordance (kappa = 0.368). Hemochron derived ACTs demonstrated worse linear correlation (r = 0.782), larger bias with considerably broader LOA (- 13.14 s 95%LOA:-316.3-290 s), and lesser concordance between parallel assays (kappa = 0.554). The test sample and reagents never enter the ‘analyser’ which transforms electrical signals from the test cartridge into human-readable results. Bias, as determined by Bland-Altman analysis, was low (- 3.8 s 95% limits of agreement (LOA): - 77.8 -70.2 s), and Cohen's Kappa demonstrated good agreement (kappa = 0.809). The i-STAT is a cartridge-based analyser with all the analytical requirements for the performance of a test contained within an individual cartridge. From the ED to the physician’s office, clinical management decisions can be made immediately and result in improved patient safety, clinical outcomes, and overall patient satisfaction. Parallel i-STAT ACTs demonstrated a good linear correlation (r = 0.985). Point-of-Care Testing Designed to provide immediate, convenient, and easy-to-use diagnostic testing. Measurements were compared between identical and different device types using linear regression, Bland-Altman analyses, and calculation of Cohen's kappa coefficient. Blood samples from 30 patients undergoing cardiac surgery on CPB were assayed at specified steps (baseline, after heparin administration, after protamine administration) with four parallel measurements (two of each device type) using commercial Kaolin activated assays provided by the respective manufactures. We evaluated the agreement of ACT assays using four parallel measurements performed on two commonly used devices each (i.e., two Hemochron Signature Elite (Hemochron) and two Abbott i-STAT (i-STAT) devices, respectively). However, concerns exist regarding reproducibility of ACT assays and comparability of devices. Since inadequate heparin anticoagulation and insufficient reversal can result in complications during cardiopulmonary bypass (CPB) surgery, heparin anticoagulation monitoring by point-of-care (POC) activated clotting time (ACT) measurements is essential for CPB initiation, maintainance, and anticoagulant reversal. ![]()
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