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Clinical Chemistry 52: 793-794, 2006; 10.1373/clinchem.2005.065433
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(Clinical Chemistry. 2006;52:793-794.)
© 2006 American Association for Clinical Chemistry, Inc.

Perspective

Prothrombin Time Testing Practices: Adherence to Guidelines and Standards

Shahram Shahangian1,a, Kathleen M. LaBeau2 and Devery A. Howerton1

1 CDC, Atlanta, GA
2 Washington State Department of Health, Shoreline, WA

aAddress correspondence to this author at: CDC, 4770 Buford Hwy, NE, G-23, Atlanta, GA 30341-3717. E-mail sshahangian@cdc.gov.

The first 20% of the full text of this article appears below.

Coagulation laboratory tests are vital to the diagnosis, treatment, and management of bleeding and hypercoagulability disorders. Some laboratories, however, fail to follow voluntary practice guidelines for coagulation testing (1)(2), and inappropriate performance of coagulation tests, such as the prothrombin time (PT) test, may contribute to coagulation and bleeding complications (3)(4). A 2001 survey of coagulation laboratory testing practices in a randomly selected sample of US hospitals revealed substantial variability in laboratory practices (1). The lack of agreement between reported practices and recommendations (1) demonstrated a need to understand the reasons for noncompliance to better promote adherence to laboratory practice guidelines and standards. In a 2004 survey of hospital laboratories and of independent and point-of-care (POC) laboratories in the US Pacific Northwest, we evaluated PT testing practices to determine the extent to which laboratories used specific practice guidelines and standards and assessed why some testing sites did not adhere to specific recommendations and regulatory standards (2)(5). Here we compare the findings of the 2001 and 2004 surveys (1)(2)(5) and discuss the extent to which guidelines are followed for certain PT testing practices.


International Sensitivity Index (ISI) of thromboplastin lot.

Several organizations, including the Clinical and Laboratory Standards Institute (CLSI; formerly NCCLS), College of American Pathologists (CAP), and American College of Chest Physicians, recommend using only thromboplastins with an ISI of 1.70 or less (2)(5). Several published studies have reported ISI values used by survey participants that together suggest increasing use of lower-ISI reagents. In the 2004 survey of PT testing practices, . . . [Full Text of this Article]


Sensitivity of PT assay to heparin.


Sodium citrate concentration.


Validation of new reagent lots.


Measurement unit for PT.


Use of voluntary practice guidelines.






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