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On-site finger prick testing or near-patient testing (NPT) with the new generation of equipment and reagents now provides acceptable INR results, comparable in accuracy to those of laboratories, provided that the test is performed by trained persons (patient, nurse, pharmacists, etc.). NPT is easy to learn and provides fast and convenient results. A drop of patient’s blood is placed on a test strip that’s then inserted in the machine, which provides a digital display of INR in less than a minute. It’s less painful and can be performed at home without the need of the patient to go to the laboratory. In some countries such as Germany, trained patients do the self-testing and self-management (adjusting anticoagulation dose depending on INR). In the U.S.A. and Canada, self management isn’t allowed.
Testing can be performed by patient, nurse, or other personnel but dose adjustment is made by the physician or a nurse or pharmacist under supervision of a doctor. In Canada, because INR testing is free for the patient, while the cost of equipment and strips for home NPT isn’t covered, NPT isn’t very popular. The major use of NPT in Canada is for children in anticoagulation clinics or hospital. NPT is also used in some hospitals prior to surgery when the surgeon or anesthetist doesn’t want to wait for the INR lab result, or in small hospitals where stat INR isn’t available on site.
Despite the fact that NPT at home is not covered in Canada, small numbers of patients who are on long-term anticoagulation, and can afford the cost, would prefer to do self-testing, rather than go to the lab for free INR testing. A meta-analysis of 14 randomized trials of self-monitoring of INR showed a significant reduction in thromboembolic events, all-cause mortality and major hemorrhage (Heneghan C et al, Lancet 2006;367:404-11). The trials of combined self-monitoring and self-adjusted therapy showed significant reduction in thromboembolic events and death, but not major hemorrhage.
- December 2011
- December 2011
