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Streamlining Activated Clotting Time Measuring Systems: Comparison of Three Point-of-Care Systems to the i-STAT.

Point-of-care (POC) activated clotting time (ACT) testing allows for the rapid and reliable assessment of hemostasis in patients undergoing heparin therapy. This is crucial for the safe management of patients during cardiopulmonary bypass, ablation in the electrophysiology laboratory, interventions in the catheterization laboratory, or extracorporeal membrane oxygenation. Three different POC ACT testing systems were being used at our institution, the HMS Plus Hemostasis Management System (HMS), Hemochron Signature Elite (Hemochron), and GEM PCL PLUS (GEM PCL). A review of performance records suggested variations in ACT measurement. We hypothesized that the observed variations in ACT measurement could be attributed to each system utiliz-ing a different testing method. In addition, none of these POC ACT systems was connected with the electronic health record (EHR), so results were manually entered. Lack of electronic capture of results increases the potential for results to be left out of the EHR. i-STATs are widely used at our institution and are connected with the EHR. Literature reports show that the i-STAT ACT has acceptable performance, so we decided to compare the existing ACT systems to the i-STAT ACT with the goal of potentially replacing all three POC systems with the i-STAT. Leftover whole blood samples collected from patients undergoing heparin therapy were tested by i-STAT following testing by one of the three existing instruments. 41 samples were analyzed on both the HMS and i-STAT, and Hemochron and i-STAT, but only 25 samples were analyzed on both the GEM PCL and i-STAT due to nonavailability of samples. Existing ACT assays were used as the reference methods. Results were compared by Deming