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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Point-of-care derived INR does not reliably detect significant coagulopathy following Australian snakebite
Kacey M O'Rourke1, Elizabeth Correlje, Cameron L Martin
1Department of Haematology, Pathology Queensland Central Laboratory, Brisbane, Queensland, Australia.
Thrombosis Research
|October 1, 2013
Summary
Point-of-care international normalised ratio (INR) testing is unreliable for diagnosing venom-induced consumption coagulopathy in Australian snakebite patients. The devices showed significant false negatives and false positives, making them unsuitable for clinical use.
Area of Science:
- Clinical Toxicology
- Hematology
- Emergency Medicine
Background:
- Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebite.
- Point-of-care (POC) international normalised ratio (INR) testing has been proposed for rapid VICC screening.
- Validation of POC INR for VICC diagnosis in snakebite is lacking.
Purpose of the Study:
- To assess the diagnostic reliability of POC INR for VICC in Australian snakebite patients.
- To compare POC INR results with laboratory coagulation analyses.
Main Methods:
- Prospective study of 15 snakebite patients (Jan 2011-May 2012).
- Simultaneous POC INR and laboratory INR measurements were performed.
- Snake identification and venom-specific enzyme immunoassay were used for confirmation.
Main Results:
- Seven patients had VICC; 4 had abnormal POC INR (3 false negatives).
- Seven patients without VICC; 1 had an abnormal POC INR (1 false positive).
- POC INR was negative in a patient with anticoagulant coagulopathy.
Conclusions:
- POC INR devices are not recommended for diagnosing VICC in Australian snakebite cases.
- The unreliability of POC INR may lead to delayed or incorrect patient management.
- Further research into validated diagnostic tools for VICC is warranted.
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