Utility of a Modified Calibration Model for Reliable Conversion of Thromboplastin Times to International Normalized Ratios

Abstract

SummaryThe combined thromboplastin reagent, Normotest, has been calibrated against the secondary international reference preparation for bovine thromboplastin, OBT/79. Three expert laboratories measured up to 62 patients on stabilized oral anticoagulant therapy and up to 20 normals in order to establish an INR-scale for Normotest. It was found that the model recommended by the WHO was less suited for the calibration of this thromboplastin. This is the first study in which three independent laboratories demonstrate a similar bias of the WHO calibration model. A modified model in which a correction factor is introduced was applied to the problem and proved to give a reliable calculation method for INR on Normotest. The mean coefficient of variation of INR calculated between measurements with Normotest and OBT/79 (scatter of data around calibration line) was 4.2-5.0% as compared to 5.1-5.7% for the WHO-method. A conversion scale for percent activities between Normotest and Thrombotest was established showing that the recommended therapeutic range of 5-10% Thrombotest (INR = 4.8-2.8) corresponds to 10-20% Normotest.