Comparison of prothrombin time derived from CoaguChek XS and laboratory test according to fibrinogen level

Abstract

Background: CoaguChek XS is one of the most widely used point-of-care (POC) devices to evaluate prothrombin time for monitoring oral anticoagulant therapy. Unlike laboratory methods, it detects electrical signals produced by thrombin activity to derive the international normalized ratio (INR). Therefore, we hypothesized that laboratory methods and CoaguChek XS could produce different results according to fibrinogen level. Methods: We compared INR values obtained from the CoaguChek XS and conventional laboratory method with 91 plasma samples covering a wide range of fibrinogen levels. Results: The samples were stratified into low, mid, and high fibrinogen groups by fibrinogen levels of <130 mg/dl, 130-450 mg/dl, and >450 mg/dl, respectively. The mean INR difference of the low fibrinogen group was significantly different from that of the mid or high fibrinogen group (P < 0.001). In the low fibrinogen group, CoaguChek XS INR showed a negative bias compared with the laboratory INR, while the mid and high fibrinogen groups had positive bias. Conclusion: Our results suggest that patient selection according to fibrinogen status should precede the implementation of POC testing using CoaguChek XS. Also, periodic comparisons between CoaguChek XS and laboratory INR results should be continued during the use of CoaguChek XS.