[Oral anticoagulation control in a cardiac surgery ward]

In patients who undergo cardiac surgery, particularly valvular surgery it is essential to carry out frequent anticoagulation controls during their hospital stay The author questions if it is viable to carry out these controls by means of a portable coagulation meter which, in principle, can provide advantages in patient care. To determine this viability the author evaluates the concordance between the measurements obtained with this device and measurements taken in a laboratory The author compared the INR (prothrombin time, Normalized International Ratio) in 106 pairs of simultaneous blood samples, from both veins and capillaries, taken from 60 patients receiving anticoagulation medicine hospitalized in the cardiac surgery ward at the La Fe Hospital after each underwent surgery The samples taken from veins were processed in a hemostasia laboratory while the capillary samples were processed with a portable coagulation meter, a Roche CoaguChek"S. The statistical analyses applied were Pearson coefficient, intraclass correlation coefficient (CCI) and the method for mean differences (MMD). Numbers for hemocytes and therapy combined with heparine were taken into account. The results showed, in the overall analysis of data, a very good degree of concordance, CCI = 0.939 (confidence interval, IC=95%, 0.902-0.961) and MMD numbers <10%. For hemocytes <32, the concordance decreases, CCI = 0.876 (IC 95% = 0.787-0.930). The author concludes that this coagulation meter is trustworthy therefore using it would improve care for a patient needing anti-coagulation treatment during his/her stay in the ward since using this meter helps to obtain immediate results and reduces the trauma when extracting blood samples, etc. Nonetheless, when dealing with patients having a low hemocyte level, it is more prudent to make use of laboratory results.