WO2000032101A1 - Procede et dispositif permettant de controler les niveaux d'anticoagulation - Google Patents

Procede et dispositif permettant de controler les niveaux d'anticoagulation Download PDF

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Publication number
WO2000032101A1
WO2000032101A1 PCT/US1999/028635 US9928635W WO0032101A1 WO 2000032101 A1 WO2000032101 A1 WO 2000032101A1 US 9928635 W US9928635 W US 9928635W WO 0032101 A1 WO0032101 A1 WO 0032101A1
Authority
WO
WIPO (PCT)
Prior art keywords
patient
blood coagulant
blood
coagulant characteristic
characteristic
Prior art date
Application number
PCT/US1999/028635
Other languages
English (en)
Inventor
D. Mark Hamlet
Original Assignee
Sulzer Carbomedics Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Sulzer Carbomedics Inc. filed Critical Sulzer Carbomedics Inc.
Priority to EP99962993A priority Critical patent/EP1135055A1/fr
Priority to JP2000584804A priority patent/JP2002531155A/ja
Priority to CA002333328A priority patent/CA2333328A1/fr
Publication of WO2000032101A1 publication Critical patent/WO2000032101A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/15—Devices for taking samples of blood
    • A61B5/150007—Details
    • A61B5/150015—Source of blood
    • A61B5/150022—Source of blood for capillary blood or interstitial fluid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/15—Devices for taking samples of blood
    • A61B5/150007—Details
    • A61B5/150847—Communication to or from blood sampling device
    • A61B5/150854—Communication to or from blood sampling device long distance, e.g. between patient's home and doctor's office
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/15—Devices for taking samples of blood
    • A61B5/150007—Details
    • A61B5/150847—Communication to or from blood sampling device
    • A61B5/150862—Communication to or from blood sampling device intermediate range, e.g. within room or building

Definitions

  • the field of the invention is patient monitoring equipment, and more particularly, equipment for monitoring the level of anticoagulation in a patient's blood.
  • Prosthetic heart valves were first introduced as a measure to combat heart disease in the 1950s.
  • the design of prosthetic heart valves has included (a) caged-ball and caged-disc valves,
  • valves tilting-disc valves, (c) bi-leaflet valves, and (d) tri-leaflet valves.
  • materials used in manufacturing the valves include metals, polymers such as delrin or plastic silicone and pyrolytic carbon.
  • Blood clotting is a natural process that is desirable in many circumstances. For example, when a person suffers a scrape or cut it is important that blood clots at the location of the cut or scrape. Otherwise, the loss of blood could be dangerous or even fatal.
  • blood clotting is not desirable and could be dangerous.
  • prosthetic heart valve designers use materials and designs that are not likely to encourage the formation of blood clots. However, for unknown reasons, these clots may still occur.
  • doctors typically prescribe the use of a drug (which are called "anticoagulants"), such as sodium warfarin, (e.g., COUMADIN offered by DuPont-Merk) which slows the clotting, or coagulation, of the blood.
  • anticoagulants such as sodium warfarin, (e.g., COUMADIN offered by DuPont-Merk) which slows the clotting, or coagulation, of the blood.
  • anticoagulant drug therapy is important. An insufficient dose of the drug may result in the undesirable formation of thrombus on or near the prosthetic heart valve (or in the circulatory system).
  • An excessive dose may cause the patient to suffer uncontrolled bleeding from the circulatory system, including from such places as the brain, gastrointestinal tract or gums after tooth brushing.
  • physicians measure the coagulation properties of blood by testing the prothrombin time (or "Pro-Time” or "PT") of the blood.
  • PT prothrombin time
  • blood is drawn from the patient and is immediately mixed with an agent that stops the blood's inherent clotting process.
  • the blood's red cells are then separated from the plasma and the plasma is mixed with a reagent that activates the clotting process.
  • the PT is the time required for clots to form after the test reagent is added to the blood or plasma sample.
  • the PT time differs for different reagents and test conditions. Consequently, an International Normalized Ratio (or "INR") was developed which normalizes the prothrombin time for different reactivating chemicals.
  • INR International Normalized Ratio
  • the physician has an idea of the coagulation properties of the patient's blood. With that information, the physician can adjust the dosage of anticoagulant drugs to produce the desired coagulation properties. Timely routine testing is essential to successful patient management. Diet, other drug interaction, different disease state, and lifestyle can affect a patient's INR.
  • the invention features a method of maintaining a desired level of anticoagulation in a patient's blood as a result of anticoagulant therapy.
  • the method comprises establishing a desired range of a blood coagulation characteristic for the patient, measuring the blood coagulation characteristic of the patient, transmitting automatically to a surveillance location digital data representing the blood coagulation characteristic, comparing the transmitted blood coagulation characteristic data to the desired range, and informing a caregiver if the transmitted blood coagulation characteristic data is outside the desired range.
  • Implementations of the invention may include one or more of the following.
  • the method may include adjusting the anticoagulant therapy to urge the blood coagulation characteristic toward the desired range.
  • the method may include informing the caregiver if the measuring does not occur within a predetermined period.
  • the method may include informing the patient if the measuring does not occur within a predetermined period.
  • Measuring may comprise using a fingerstick blood coagulation characteristic tester.
  • Measuring may comprise measuring the prothrombin time of the patient's blood or the international normalized ratio of the patient's blood.
  • the method made comprise building a database of said data from each patient.
  • the method may comprise repeatedly establishing, measuring, comparing, and informing for multiple patients, and compiling a database of blood coagulation characteristics.
  • the invention features a database of multiple patient blood coagulation characteristics resulting from the method just described.
  • the invention features a system for monitoring a blood coagulation characteristic for a patient after the patient has undergone prosthetic heart valve implant surgery and is undergoing an anticoagulation therapy.
  • the system comprises a blood coagulation characteristic tester configured to electronically report a coagulant characteristic, and a surveillance process configured to receive and analyze the coagulant characteristic and to notify a caregiver if the coagulant characteristic is outside a desired range, the desired range chosen to reduce the likelihood of formation of thrombus or clotting in a patient after heart valve implant surgery.
  • the system also comprises a communications medium configured to allow the caregiver to contact the patient to adjust the anticoagulation therapy to urge the coagulant characteristic toward the desired range.
  • Implementations of the invention may include one or more of the following.
  • the communications medium may be additionally configured to notify the patient and the caregiver if the surveillance process is not completed within a predetermined time.
  • the blood coagulation characteristic tester may electronically report the coagulation characteristic telephonically.
  • the blood coagulation characteristic tester may electronically report the coagulation characteristic by radio, by satellite link or over a network.
  • the invention features a kit for monitoring a blood coagulation characteristic of a patient after the patient has undergone prosthetic heart valve implant surgery.
  • the kit comprises a prosthetic heart valve, a blood coagulation characteristic tester configured to electronically report a coagulant characteristic, and a surveillance process configured to receive and analyze the coagulant characteristic.
  • Implementations of the invention may include one or more of the following.
  • the surveillance process may be configured to notify a caregiver if the coagulant characteristic is outside a desired range, the desired range chosen to reduce the likelihood of formation of thrombus or clotting in the patient after the heart valve implant surgery.
  • the surveillance process may comprise means to notify the patient and the caregiver if the tester malfunctions or fails to report within a predetermined period.
  • the surveillance process may be configured to provide a first level of notification to the caregiver if the coagulant characteristic is outside the desired range by a first amount and a second level of notification to the caregiver if the coagulant characteristic is outside the desired range by a second amount.
  • Fig. 1 is a perspective view of a portion of a system according to the present invention.
  • Fig. 2 is a block diagram of a system according to the present invention.
  • Fig. 3 is a flow chart.
  • the invention improves the monitoring and adjustment of blood coagulation properties by automatically reporting the results of a patient-administered blood coagulation test to a surveillance system.
  • the surveillance system determines whether the blood coagulation properties are within a preselected range and decides whether it is necessary to alert a caregiver if the property is outside that range.
  • the invention includes a kit, comprising a heart valve prosthesis, a blood coagulation characteristic test device, and a surveillance process. This kit may be provided to a caregiver prior to heart valve implant surgery. After surgery the patient and caregiver use the blood coagulation property test device and the surveillance process, as described below.
  • the patient 100 who may have a prosthetic heart valve (not shown), draws blood 102 by pricking or incising his or her finger, as shown in Fig. 1.
  • the drop of blood 102 is dropped into an analysis chamber 104 of a blood coagulation characteristic test device 106.
  • the blood coagulation characteristic test device 106 tests the blood 102 for a blood coagulation property.
  • the coagulation test device may administer a PT test and then compute the INR and the blood coagulation property could be the PT or the INR.
  • the PRO TIME Microcoagulation System by International Technidyne Corporation, a number of devices manufactured and sold by Boehringer Mannheim Corporation, and a device manufactured and sold by Avocet Medical, Inc., all perform this function. All of these devices are fingerstick blood coagulation characteristic testers, in that they require the patient to prick or incise his or her finger in order to draw blood for analysis.
  • the blood coagulation characteristic test device 106 communicates data representing the blood coagulation property to a communication device 108 via cable 110.
  • the communication device 108 may be incorporated into the blood coagulation characteristic test device 106.
  • the communication device 108 formats and conditions the data representing the blood coagulation property for transmission via cable 112.
  • the equipment illustrated in Fig. 1 is part of the patient-location equipment 114.
  • the patient-location equipment 114 is at a patient location 202, as shown in Fig. 2.
  • the patient-location equipment 114 communicates the data representing the blood coagulation property to a surveillance location 204.
  • the communication can be through uplink antenna 206 to satellite 208 to downlink antenna 209.
  • the communication can be through a radio transmitter 210 to a radio receiver 212 at a communications media transfer point 214.
  • the communications media transfer point may transmit the data to the surveillance location via uplink antenna 216 to satellite 208 to downlink antenna 209.
  • the data could be transferred from the patient location 202 to the communications media transfer point 214 over a telephone system 218.
  • the data could be transferred to the surveillance location 204 from the communications media transfer point 214 over a telephone system 220.
  • Transfer over the telephone system may include transfer over a network, such as the Internet.
  • a network such as the Internet, could use the broadcast cable system as a communications media.
  • any combination of these communication approaches is within the scope of the invention as long as the data is transferred from the patient location 202 to the surveillance location 204, ultimately allowing the patient's caregiver to review the data so that the caregiver can adjust the anticoagulation therapy to urge the coagulation characteristic toward the desired range.
  • the data arrives at the surveillance location 204, it must be analyzed to determine if it falls within a range established by the caregiver in accordance with the patient's needs. For example, a physician may prescribe that a patient's INR should fall within the range 2.8 through 3.4.
  • the surveillance location will compare the INR reported from the patient location to see if it is greater than 2.8 and less than 3.4.
  • the analysis at the surveillance location is illustrated in Fig. 3, and may be accomplished by computer 221 at the surveillance location, shown in Fig. 2.
  • the analysis begins 302 by determining if the blood coagulation property is within the desired range 304. If it is, the analysis ends 306, and is stored in a database for an undetermined time, and made available to the patient's physician.
  • the appropriate response must be determined. The more the blood coagulation property deviates from the desired range the more extreme the response will have to be. For example, if the blood coagulation level is less than X outside the desired range (which is determined by test 308), an alert procedure 310 is followed. Under this procedure, for example, the patient is contacted and advised to consult with his or her caregiver.
  • an extreme alert procedure 314 is followed. Under this procedure, for example, the patient's caregiver is called during working hours to inform him or her of the test results .
  • an emergency procedure 316 is followed. Under this procedure, for example, the patient's physician is called as soon as the emergency condition is detected, even if it is outside normal working hours.
  • an INR database can be created using data from multiple monitored patients. This database can be available to caregivers to provide historical data for patient management decisions both by specific patient, by subset of patients, and by global data of all patients. Further, the database can provide an indication of when data from a particular patient has not been received for a predetermined period of time. The failure to receive data could be due to a variety of reasons, including a malfunction of the blood characteristic tester or of any of the communications equipment in the system. The failure could also be due to the patient neglecting to administer the test. In any of these cases, the caregiver can contact the patient and determine why data has not been received from that patient.
  • a number of companies provide the surveillance service required at the surveillance location.
  • Raytel Cardiac Services, Inc. provides a pacemaker monitoring service which could be modified to provide the required service.
  • the surveillance location 204 can communicate with the caregiver at the caregiver location 222 via antenna 209, through satellite 208 and downlink antenna 224.
  • the communication could be via telephone system 226.
  • the communication between the caregiver location 222 and the patient location 202 could be by telephone system 228 or by any of the other communication media discussed above.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Computer Networks & Wireless Communication (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • External Artificial Organs (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Mobile Radio Communication Systems (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)

Abstract

L'invention concerne un procédé, un appareil et un kit permettant de maintenir dans le sang d'un patient un niveau d'anticoagulation thérapeutique, suite à l'administration d'anticoagulants. On établit une gamme souhaitée de caractéristique de coagulation sanguine pour le patient (gamme d'INR). La caractéristique de coagulation du patient est déterminée et transmise automatiquement à un site de contrôle sous la forme de données numériques. Ensuite, cette caractéristique est comparée à la gamme souhaitée. Une personne soignante est informée lorsque les données sont en dehors de la gamme souhaitée, ou lorsque les procédures d'essai et de notification ne se déroulent pas en temps opportun.
PCT/US1999/028635 1998-12-02 1999-12-02 Procede et dispositif permettant de controler les niveaux d'anticoagulation WO2000032101A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
EP99962993A EP1135055A1 (fr) 1998-12-02 1999-12-02 Procede et dispositif permettant de controler les niveaux d'anticoagulation
JP2000584804A JP2002531155A (ja) 1998-12-02 1999-12-02 抗凝固レベル観測方法および装置
CA002333328A CA2333328A1 (fr) 1998-12-02 1999-12-02 Procede et dispositif permettant de controler les niveaux d'anticoagulation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US20381498A 1998-12-02 1998-12-02
US09/203,814 1998-12-02

Publications (1)

Publication Number Publication Date
WO2000032101A1 true WO2000032101A1 (fr) 2000-06-08

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Application Number Title Priority Date Filing Date
PCT/US1999/028635 WO2000032101A1 (fr) 1998-12-02 1999-12-02 Procede et dispositif permettant de controler les niveaux d'anticoagulation

Country Status (4)

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EP (1) EP1135055A1 (fr)
JP (1) JP2002531155A (fr)
CA (1) CA2333328A1 (fr)
WO (1) WO2000032101A1 (fr)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001093762A2 (fr) * 2000-06-09 2001-12-13 Medimage Aps Procede a securite integree assistee par ordinateur pour traitement anticoagulant
EP1226781A2 (fr) * 2001-01-25 2002-07-31 Siemens Aktiengesellschaft Système médical de surveillance d'une valeur de mesure de la coagulation sanguine d'un patient
EP1260173A2 (fr) * 2001-05-23 2002-11-27 Siemens Aktiengesellschaft Système médical pour la surveillance des patients à domicile
WO2003019455A2 (fr) * 2001-08-22 2003-03-06 Keystone Therapeutics, Inc. Systeme, procede et programme informatique pour surveiller et gerer des medications
US11129544B2 (en) 2011-01-28 2021-09-28 Bar Ilan University Method and system for non-invasively monitoring biological or biochemical parameters of individual

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2879568A1 (fr) * 2012-08-01 2015-06-10 Bar Ilan University Procédé et système pour la surveillance non invasive de paramètres biologiques ou biochimiques d'un individu

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0680727A1 (fr) * 1994-05-05 1995-11-08 Roche Diagnostics GmbH Sytème d'analyse pour surveiller la concentration d'un analyte dans le sang d'un patient

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0680727A1 (fr) * 1994-05-05 1995-11-08 Roche Diagnostics GmbH Sytème d'analyse pour surveiller la concentration d'un analyte dans le sang d'un patient

Non-Patent Citations (3)

* Cited by examiner, † Cited by third party
Title
H.I.BUSSEY ET AL: "controversies in antithrombotic therapy for patients with mechanical heart valves", PHARMACOTHERAPY, vol. 18, no. 3, March 1998 (1998-03-01), pages 451 - 662, XP000889919 *
JACK E. ANSELL ET AL: "long-term patient self-management of oral anticoagulation", ARCHIVES OF INTERNAL MEDICINE, vol. 155, 1995, pages 2185 - 2189, XP002133584 *
JACK E. ANSELL ETAL: "consensus guidelines for coordinated outpatient oral anticoagulation therapy management", ANNALS OF PHARMACOTHERAPY, vol. 31, 1997, pages 604 - 615, XP002133585 *

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001093762A2 (fr) * 2000-06-09 2001-12-13 Medimage Aps Procede a securite integree assistee par ordinateur pour traitement anticoagulant
WO2001093762A3 (fr) * 2000-06-09 2002-03-07 Medimage Aps Procede a securite integree assistee par ordinateur pour traitement anticoagulant
EP1226781A2 (fr) * 2001-01-25 2002-07-31 Siemens Aktiengesellschaft Système médical de surveillance d'une valeur de mesure de la coagulation sanguine d'un patient
EP1226781A3 (fr) * 2001-01-25 2002-09-25 Siemens Aktiengesellschaft Système médical de surveillance d'une valeur de mesure de la coagulation sanguine d'un patient
US6730026B2 (en) 2001-01-25 2004-05-04 Siemens Aktiengesellschaft Medical system for monitoring a measured value of a patient relating to blood-clotting
EP1260173A2 (fr) * 2001-05-23 2002-11-27 Siemens Aktiengesellschaft Système médical pour la surveillance des patients à domicile
EP1260173A3 (fr) * 2001-05-23 2003-06-04 Siemens Aktiengesellschaft Système médical pour la surveillance des patients à domicile
WO2003019455A2 (fr) * 2001-08-22 2003-03-06 Keystone Therapeutics, Inc. Systeme, procede et programme informatique pour surveiller et gerer des medications
WO2003019455A3 (fr) * 2001-08-22 2004-04-01 Keystone Therapeutics Inc Systeme, procede et programme informatique pour surveiller et gerer des medications
US11129544B2 (en) 2011-01-28 2021-09-28 Bar Ilan University Method and system for non-invasively monitoring biological or biochemical parameters of individual

Also Published As

Publication number Publication date
EP1135055A1 (fr) 2001-09-26
CA2333328A1 (fr) 2000-06-08
JP2002531155A (ja) 2002-09-24

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