K Number
K060978
Device Name
COAGUCHEK XS SYSTEM
Manufacturer
Date Cleared
2006-08-11

(123 days)

Product Code
Regulation Number
864.7750
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The CoaguChek XS System is intended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The CoaguChek XS System uses fresh capillary or non-anticoagulated venous whole blood.
Device Description
The CoaguChek XS is a 3rd generation CoaguChek meter which measures prothrombin time in fresh capillary or non-anticoagulated venous whole blood samples. The CoaguChek XS System incorporates many of the perspectives shared by FDA during reviews of our previous systems, including but not limited to integrated quality control and a blood application area that is outside the meter. The CoaguChek XS System includes a meter and CoaguChek XS PT test strips. Each box of test strips has its own code chip that you insert into the meter. The code chip contains important information about the test strips such as their expiration date and lot number. The meter and test strips work together to provide a safe and reliable system for testing blood-clotting time.
More Information

Not Found

No
The summary describes a blood coagulation testing system that measures prothrombin time using a meter and test strips. There is no mention of AI, ML, or related concepts in the intended use, device description, or performance studies. The system appears to rely on established electrochemical or optical measurement principles rather than AI/ML algorithms for data analysis or interpretation.

No
This device is for monitoring warfarin therapy, which is a diagnostic function, not a therapeutic one. It measures prothrombin time, which helps in managing a patient's medication but does not directly treat a condition.

Yes

The device is intended for quantitative prothrombin time testing to monitor warfarin therapy, which is a diagnostic purpose to assess a patient's coagulation status.

No

The device description explicitly states that the system includes a "meter and CoaguChek XS PT test strips," which are hardware components.

Yes, this device is an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use explicitly states "quantitative prothrombin time testing for the monitoring of warfarin therapy" using "fresh capillary or non-anticoagulated venous whole blood." This describes a test performed on a biological sample (blood) outside of the body to provide information about a patient's health status (blood clotting time for warfarin monitoring).
  • Device Description: The description details a "meter and CoaguChek XS PT test strips" that "measure prothrombin time in fresh capillary or non-anticoagulated venous whole blood samples." This further confirms that the device is designed to perform a diagnostic test on a biological sample.
  • Performance Studies: The inclusion of performance studies evaluating accuracy and precision using blood samples (capillary and venous) against a reference method (Sysmex Analyzer) is typical for IVD devices to demonstrate their analytical performance.

The definition of an IVD generally includes devices intended for use in vitro for the examination of specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. The CoaguChek XS System clearly fits this definition.

N/A

Intended Use / Indications for Use

The CoaguChek XS System is intended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The CoaguChek XS System uses fresh capillary or non-anticoagulated venous whole blood.

Product codes

GJS

Device Description

The CoaguChek XS is a 3rd generation CoaguChek meter which measures prothrombin time in fresh capillary or non-anticoagulated venous whole blood samples. The CoaguChek XS System incorporates many of the perspectives shared by FDA during reviews of our previous systems, including but not limited to integrated quality control and a blood application area that is outside the meter. The CoaguChek XS System includes a meter and CoaguChek XS PT test strips. Each box of test strips has its own code chip that you insert into the meter. The code chip contains important information about the test strips such as their expiration date and lot number. The meter and test strips work together to provide a safe and reliable system for testing blood-clotting time.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

professional healthcare providers

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Capillary Accuracy (All Sites)
N= 700
y= 1.006x + 0.032
Correlation: 0.971

Venous Accuracy (All Sites)
N= 710
Y= 1.034x - 0.02
Correlation: 0.974

Precision with blood
Venous:
N = 357
Mean = 2.59 INR
SD = 0.06
CV = 2.42

Capillary:
N = 344
Mean = 2.59 INR
SD = 0.11
CV = 4.35

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K020831

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 864.7750 Prothrombin time test.

(a)
Identification. A prothrombin time test is a device used as a general screening procedure for the detection of possible clotting factor deficiencies in the extrinsic coagulation pathway, which involves the reaction between coagulation factors III and VII, and to monitor patients receiving coumarin therapy (the administration of one of the coumarin anticoagulants in the treatment of venous thrombosis or pulmonary embolism).(b)
Classification. Class II (performance standards).

0

K060978

AUG 】】2006

510(k) Summary

| Introduction | According to the requirements of 21 CFR 807.92, the following information
provides sufficient detail to understand the basis for a determination of
substantial equivalence. |
|-------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1) Submitter
name, address,
contact | Roche Diagnostics Corporation
9115 Hague Rd.
Indianapolis, IN 46250 |
| | Contact Person: Jennifer Tribbett |
| | Date Prepared: April 6, 2006 |
| 2) Device name | Proprietary name: CoaguChek® XS System
Common name: Prothrombin time test
Classification name: Prothrombin time test |
| 3) Predicate
device | The Roche Diagnostics CoaguChek XS System is substantially equivalent to
other products in commercial distribution intended for similar use. Most
notably, it is substantially equivalent to the Roche Diagnostics CoaguChek S
System (K020831). |
| 4) Device
Description | The CoaguChek XS is a 3rd generation CoaguChek meter which measures
prothrombin time in fresh capillary or non-anticoagulated venous whole blood
samples.
The CoaguChek XS System incorporates many of the perspectives shared by
FDA during reviews of our previous systems, including but not limited to
integrated quality control and a blood application area that is outside the meter.
The CoaguChek XS System includes a meter and CoaguChek XS PT test
strips. Each box of test strips has its own code chip that you insert into the
meter. The code chip contains important information about the test strips such
as their expiration date and lot number. The meter and test strips work
together to provide a safe and reliable system for testing blood-clotting time. |

1

  • The CoaguChek XS System is intended for use by professional healthcare 5) Intended Use providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The CoaguChek XS System uses fresh capillary or nonanticoagulated venous whole blood.
  • The CoaguChek XS System is similar to the predicate CoaguChek S 6) Similarities to predicate device System in the following items:
TopicComment
Intended UseBoth are intended to be used by professional healthcare
providers for the quantitative prothrombin time (PT) testing
to monitor warfarin therapy, using fresh capillary or non-
anticoagulated venous whole blood.
Measuring RangeBoth systems have a measuring range of 0.8 – 8.0 INR.
Closed SystemBoth systems use instrument and reagent strips that are
provided by Roche and are intended to be used together.
Specimen collection and
preparation instructionsThese instructions are the same for both systems.
Sample VolumeBoth require a minimum of 10 $ $\mu$ $ L capillary blood
ThromboplastinBoth contain human recombinant thromboplastin, stabilizers
and preservatives.
International Sensitivity IndexBoth have an ISI established as 1.
Calibration of resultsBoth systems are traceable to the WHO reference method.

The following table lists the major differences between the CoaguChek 7) Differences from predicate device XS System and the predicate CoaguChek S System.

TopicCoaguChek XS SystemCoaguChek S System (Predicate)
TechnologyElectrochemical technology with
amperometric (electric current)
detection of thrombin activity.Dancing particle technology with
optical detection of thrombin activity.
Quality ControlOn-board fully integrated quality
controls which use electrochemical
signals to detect test strip integrity.Liquid controls and external
electronic quality control
Test Strip DosingTop and side dosingTop dosing only
Start upInstrument turns on with either the
insertion of the test strip or the push
of a buttonInstrument turns on with the push of a
button
Memory100 test results with time & date60 test results with time & date
ClaimCoaguChek XS SystemCoaguChek S System
(Predicate)
BilirubinNo significant effect up to 30 mg/dLNo significant effect up to 20 mg/dL
HemolysisNo significant effect up to 1000 mg/dLNo significant effect up to 500 mg/dL
TriglyceridesNo significant effect up to 500 mg/dLNo significant effect up to 500 mg/dL
HematocritHematocrit ranges between 25 - 55%
do not significantly affect test results.Hematocrit ranges between 32 - 52%
do not significantly affect test results.
HeparinUnaffected by heparin concentrations
up to 0.8 U/mL.Unaffected by heparin concentrations
up to 2.0 U/mL.
Low Molecular
Weight HeparinInsensitive to low molecular weight
heparins up to 2 IU anti-factor Xa
activity/mL.Insensitive to low molecular weight
heparins up to 1 IU anti-factor Xa
activity/mL.
Capillary
Accuracy
(All Sites)Capillary blood on CoaguChek XS vs.
venous plasma on a Sysmex Analyzer
using Dade Innovin (ISI = 1.02)
N= 700
$y= 1.006x + 0.032$
Correlation: 0.971Capillary blood on CoaguChek S vs.
venous plasma on MLA 900 using
Ortho Recombiplastin (ISI = 1.03)
N= 539
$y= 1.150x - 0.25$
Correlation: 0.965
Venous
Accuracy
(All Sites)Venous Whole Blood:
CoaguChek XS vs. Sysmex Analyzer
using Dade Innovin (ISI = 1.02)
N= 710
$Y= 1.034x - 0.02$
Correlation: 0.974Venous Whole Blood:
CoaguChek S vs. MLA 900 using
Ortho Recombiplastin (ISI = 1.03)
N= 761
$Y= 1.150x - 0.24$
Correlation: 0.970
ClaimCoaguChek XS SystemCoaguChek S System
(Predicate)
Precision with
bloodWhole blood precision for venous and
capillary samples was determined from
sample duplicates collected at three
external sites.Whole blood precision was
determined from sample duplicates at
five external sites for the venous
blood and four external sites for the
capillary blood.
Bland Altman plots for both capillary
and venous blood are provided in the
test strip insert.Bland Altman plots for both capillary
and venous blood are provided in the
test strip insert.
The following information represents
the data that is graphically shown by
the Bland Altman plots.Venous:The following information represents
the data that is graphically shown by
the Bland Altman plots.
Venous:Venous:
N = 357
Mean = 2.59 INR
SD = 0.06
CV = 2.42N = 376
Mean = 2.5 INR
SD = 0.11
CV = 4.43
Capillary:Capillary:
N = 344
Mean = 2.59 INR
SD = 0.11
CV = 4.35N = 268
Mean = 2.1 INR
SD = 0.15
CV = 7.19

Continued on next page

2

The following chart shows a comparison of performance characteristic 8) Performance characteristics claims for the CoaguChek XS System and the CoaguChek S System.

Continued on next page

3

Performance -Continuedcharacteristics

.

4

DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service

Image /page/4/Picture/2 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three wavy lines extending from its wing. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the eagle.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

AUG 1 1 2006

ROCHE DIAGNOSTICS c/o Jennifer Tribbett 9115 Hague Road Indianapolis, IN 46256

Re: K060978/S001 CoaguChek® XS System Regulation Number: 21 CFR 864.7750 Regulation Name: Prothrombin Time Test Regulatory Class: Class II Product Code: GJS Dated: April 6, 2006 Received: April 10, 2006

Dear Ms. Tribbett:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in Title 21, Code of Federal Regulations (CFR), Parts 800 to 895. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Parts 801 and 809); and good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820). This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed

5

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predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific information about the application of labeling requirements to your device, rryou don't specific introlion and advertising of your device, please contact the Office of In of questions on the proce Evaluation and Safety at (301) 594-3084. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). regulation other general information on your responsibilities under the Act from the Tou may of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (240) 276-3150, or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Robert L. Betz

Robert L. Becker, Jr., MD. PMD. Director Division of Immunology and Hematology Office of In Vitro Diagnostic Device Evaluation and Safety Center for Devices and Radiological Health

Enclosure

6

Indications for Use

510(k) Number (if known):

K060978

Device Name: CoaguChek® XS System

Indications For Use:

The CoaguChek XS System is intended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The CoaguChek XS System uses fresh capillary or non-anticoagulated venous whole blood.

Prescription Use X (Part 21 CFR 801 Subpart D) AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Aurghine Bautista
Division Sign-Off

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Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) K060978