Abstract

The International Normalizing Ratio (INR) measures the speed at which blood clots. Healthy people have an INR of about one. Some people are at greater risk of blood clots and their physician prescribes a target INR range, generally 2-3. The farther a patient is above or below their prescribed range, the more dangerous their situation. A variety of point-of-care (POC) devices has been developed to monitor patients. The purpose of this research was to develop innovative graphics to help describe a highly unbalanced dataset and to carry out Bayesian analyses to determine which of five devices best manages patients. An initial Bayesian analysis compared a machine-identical beta-binomial model to a machine-specific beta-binomial model. The response variable was number of in-range visits. A second Bayesian analysis compared a machine-identical lognormal model, a machine-specific lognormal model, and a machine-specific lognormal model with lower therapeutic bound as a predictor. The response variable was INR. Machines were compared using posterior predictive distributions of the absolute distance outside a patient's therapeutic range. For the beta-binomial models, the machine-identical model had the lower DIC, meaning that POC device was not a strong predictor of success in keeping a patient in-range. The machine-specific lognormal model with a term for lower therapeutic bound had the lowest DIC of the three lognormal models, implying that the additional information of distance out of range revealed differences among the POC devices. Three of the machines had more favorable out-of-range distributions than the other two. Both Bayesian analyses provided useful information for medical practice in managing INR.

Degree

College and Department

Physical and Mathematical Sciences; Statistics

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