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r ’ ICoaguChek XS and XS PlusA range that brings a new level of confidencein INR monitoring, for you and your patientsXSXS Plus

The policy of practice based commissioning aims toencourage individual practices to provide local andflexible services to patients.Locally based services can:Offer more choice for patients and practicesReduce the burden on secondary careAllow practices to fund further service improvements from potentialbudgetary savingsSupporting patient self carePatient self care is a key initiative in the NHS Planfor a patient centred health service and an importantcomponent in supporting people with longterm conditions.2Encouraging involvement and responsibilitythrough ‘expert patient’ programmes and greaterpatient self care, can benefit both patient andpractice through:Improved symptom management and patient quality of life3More independence for the patient4Implementing a near-patient(NPT) INR testing service in your clinic can:Help monitor patients more closely for bettertherapy management and improved outcomes1Reduced GP consultations and hospital admissionsPatient self-testing (PST) for appropriate patientson anticoagulation therapy can:Offer patients a local, convenientalternative to a hospital basedanticoagulation clinicGive patients more freedom through fewer visits to the clinic andallow regular monitoring – even on holiday or other times whenroutines and diet can changeImprove patient relations through moreinvolvement and greater confidenceEntitle the clinic to receive up to 128 perINR managed patient under the GMS contractReduce your team’s time spent liaisingwith hospital laboratoriesReduce the risk of complications throughfactors including:1Benefit your practice with Level 4reimbursement for INR testedpatients through the enhancedservices GMS contract- More time spent in therapeutic range5- Empowerment of the patient1- Encouragement to adhereto self-management strategy1- Increased awareness of health status1Consider implementing patient centred services, either as a nearpatient testing clinic (NPT) or patient self-testing (PST) forappropriate warfarin and other anticoagulation therapy patientsService DeliveryA patient centred servicein anticoagulation therapy

Leading the way in INR monitoringCoaguChek SThe CoaguChek range of products has been leading the wayin INR monitoring since 1993 and has helped many thousandsof patients and healthcare professionals to manage oralanticoagulation therapy effectively.The market leading CoaguChek S provides fast and accurate resultsand is suitable for both NPT and PST.PortfolioCoaguChek meters:Extensive technical evaluations including MHRAExtensive clinical evidenceProvides results in less thantwo minutesSupported by unparalleled service and technicaladvice lines87% of PST patients foundCoaguChek S straightforwardto use6Strips available on prescriptionMeter kits include lancing device, lancets, starter packof test strips, batteries and/or power leadMHRA evaluated and reviewedby NEQAS (UK National ExternalQuality Assessment Service)Proven to be a safe and accuratealternative to laboratory INRtesting6CoaguChek S test stripsTest strips continue to beavailable on NHS prescriptionStrips available in packsof 12 or 48

NEW CoaguChek XSNEW CoaguChek XS PlusCombines state of the art INR monitoring technology witha compact design that meets the levels of accuracy, safetyand convenience essential for patient self-testing.Specifically designed with a range of enhanced features,CoaguChek XS Plus is the ideal INR testing meter for primaryand secondary care environments.PortfolioActual sizeFull graphical touch screenfor simple and fast handlingAudit facility with patientand user identificationElectrochemical principleAbility to set individualtherapeutic rangeDownload capabilities andintegrated data managementfunctionsCompact, hand held designand battery operation for addedconvenienceAccurate results within 1 minute500 result memoryLarge graphic display and easyto follow operation100 result memoryMains and battery power supplyfor in-clinic or home visit usePlus many more features foraccuracy and convenienceCoaguChek XS Plus ProthrombinTime (PT) liquid controls availableTest stripsUnique On-Board Control Systemusing single channel technologyensures accurate day to dayrunning of the meter, thereforeno need for control solutionHuman recombinantthromboplastin has InternationalSensitivity Index (ISI) 1.0 forgreater test accuracyTop and side dosing outsideof meter for easier applicationsignificantly reducing the riskof contaminationStrips stored at room temperature– no need for refrigerationStrips available on NHSprescription in packs of 24 or 48XS strips are compatible withboth XS and XS Plus meters

Continuing reassuranceAccuracy you can trustOur ongoing commitment to product innovation means that thenew generation of CoaguChek meters provides unsurpassedlevels of convenience and reassurance to patients and healthcareprofessionals alike.CoaguChek XS meters are designed with the highest levels of accuracyin mind. By incorporating the latest developments in INR monitoringtechnology, you can be sure that CoaguChek XS meters give accurateand precise results to ensure that your patients receive the mosteffective therapy management.Low ISI PT reagent:Evaluation of CoaguChek XSCompliant with WHO recommendationsInsensitive to heparin* Heparin concentrations up to 1 U/ml, low molecular weight heparin (LMWH) up to 2 IU antifactor Xa activityInterferences543210Haematocrit no effect from 25% to 55% (Hct)123456Dade Innovin (lot 536910, MLA 900,Vacutainer; ISI 0.98/MNPT 10.4s) [INR]Method Comparison of Duplicate Determinationswith the CoaguChek XS Master Lot8CoaguChek XS (Master Lot, meter B) [INR]Fibrinogen no effect from 167 to 600mg/dlConfidenceReagent is insensitive to heparin allowing continuous monitoringthroughout the heparin to warfarin transition*6CoagChekXS PT(EBC03; venous) [INR]Human recombinant thromboplastin has International SensitivityIndex (ISI) 1.0 for greater test accuracyEvaluation of CoaguChek XS system vs Innovin776543r 0.999n 378y 1.001x - 0.002CV 1.1%21The duplicate determinationswith the CoaguChek XSsystem showed very lowimprecision (high precision)for the master lot INRresults with a CV of 1.1%0012345678CoaguChek XS (Master Lot, meter A) [INR]The master lot of the new CoaguChek XS systemwas successfully calibrated with high precisionaccording to WHO guidelines8

Confidence through technologyImproving quality of lifeThe new electrochemical technology utilised in CoaguChek XSproducts has advantages over dancing particle, electrical resistanceand electrical impedance methods and helps ensure even greateraccuracy in PT results.Regular testing can improve patients’ quality of life – withindependence and better organisation of leisure and holiday timebeing most frequently mentioned advantages.3Unique On-Board-Integrated-System Control:Satisfaction with self-monitoring comparedto conventional care5Automatic on board integrity check ensures accurate day to dayrunning of the meterDevice and strip are constantly checked during measuring processand detects insufficient blood sample6 Total satisfaction Self-monitoring5.44.84 Conventional Care4.5Haematocrit correctionConfidenceOn-Board Single Channel Strip Control- Built in controls to protect strip integrity1 Total dissatisfaction- Detection of used or out of date strips- Control and reagent is delivered through same channelfor improved quality controlGeneraltreatmentsatisfactionAdapted from Cromheecke M et al5SelfEfficacyCompared to conventional care,self-monitoring reduced:New dose application:Top and side dosing outside of meterfor easier application and greatercontamination controlDaily worriesDistressSocial issuesSide dosingTop dosingof the therapeutic benefits of self-testing“ Iandamforcertainanyone who travels abroad it can be invaluable.”more confident because I know that I am within“ Imyamtherapeuticrange.”99

Improving clinical outcomesTest frequencyRegular INR monitoring can help improve anticoagulationtherapy management and consequently have a positive impacton clinical outcomes.Encouraging patients to INR test more regularly, either at an NPTclinic or through PST, can help improve therapeutic managementand encourage greater involvement in their treatment.PT times should be monitored frequently to determine the safestdose and minimise the risk of complications3Monitoring weekly, 85% of patients stayed within target range,compared with around 50% monitoring monthly10Improved anticoagulation control results in improved outcomeswith a decrease in the incidence of haemorrhage andthromboembolic events,11 by up to 55%10Adverse events are generally the result of poor therapeutic control11Patient self-management of oral anticoagulation treatmentdecreased the incidence of major complications comparedto conventional management1A recent study of over 2800 patients with a mechanical heart valvereplacement suggests that fluctuations in INR measurements werethe strongest predictors of both thromboembolic and bleeding eventsSelf-managing patients stuck to their INR range with higher accuracythan those on a conventional management programme12INR values after aortic and mitral valve ,82,62,42,2Mitral valve replacementINR coagulation self-monitoring2 4 6 8 10 12 14 16 18 20 22 24Months after heart valve operationINR values and variances from the ESCAT 1 study bycourtesy of Dr. H. KörtkeIn another study, the proportion of patients who spent most time in thetherapeutic target range was larger during self-management than duringanticoagulation clinic-guided management5A UK based study showed that 70% of patients who self-managed overa 12 month period, stayed within their therapeutic range when INRtesting every two weeks13Improving outcomes0Aortic valve replacement

Support services for your patientsCoaguChek XS meter kit contains:- Instruction manual- ‘Step-by-step’ demonstration video- Contact phone numbersSupport services for your clinicRoche work in partnership with PCOs to help set up NPT clinicsand PST support servicesRoche anticoagulation training workshops for clinic staff deliveredby specialist trainers, include subjects such as:- Training to local guidelinesCoaguChek Careline for:- Detailed product training- Comprehensive product information- Refining and expanding an anticoagulation service- Training advice- Mentoring- Lifestyle support- Follow up to review progress and provide refresher trainingTechnical Helpline provides:- Answers to any questions about the meterUniversity of Birmingham accredited Anticoagulation ManagementTraining Courses for HCPs:- Patient self-testing/management training (train the trainer)- 3 day oral anticoagulation management trainingOngoing in-clinic training support from Roche Diagnostics representativesSupportWhether you are considering NPT or recommending CoaguChek toyour patients for self-testing, please call 01273 484567 or contactyour Roche Diagnostics representative for more information.