K Number
K071041
Device Name
COAGUCHEK XS PLUS SYSTEM
Manufacturer
Date Cleared
2007-05-11

(29 days)

Product Code
Regulation Number
864.7750
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The CoaguChek XS Plus System is intended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The system uses fresh capillary or non-anticoagulated venous whole blood.
Device Description
The CoaguChek XS Plus system is a portable coagulation monitoring system to monitor prothrombin time (PT) in patients receiving oral anticoagulant therapy. The system uses the amperometric detection of thrombin in the blood sample. A test strip is used to determine a PT value from 10 uL of whole blood. Onboard quality control is available on every test strip and the system also features an optional external quality control material (CoaguChek XS PT Control).
More Information

Not Found

No
The description focuses on electrochemical detection and standard statistical analysis of performance, with no mention of AI or ML terms or concepts.

No.
The device is for monitoring a patient's condition (prothrombin time) to guide therapy, not for providing therapy itself.

Yes

The device quantitatively measures prothrombin time to monitor warfarin therapy, which is a diagnostic function used by healthcare providers to assess a patient's condition and guide treatment.

No

The device description clearly states it is a "portable coagulation monitoring system" that uses a "test strip" and "amperometric detection," indicating it is a hardware device that utilizes software for processing and display, not a software-only device.

Yes, the CoaguChek XS Plus System is an IVD (In Vitro Diagnostic) device.

Here's why:

  • Intended Use: The intended use clearly states it's for "quantitative prothrombin time testing for the monitoring of warfarin therapy" using "fresh capillary or non-anticoagulated venous whole blood." This involves testing a sample taken from the human body (blood) in vitro (outside the body) to provide diagnostic information (monitoring warfarin therapy).
  • Device Description: The description further clarifies that it's a "portable coagulation monitoring system to monitor prothrombin time (PT)" and uses a "test strip" and "whole blood." This aligns with the typical characteristics of an IVD device that analyzes biological samples.
  • Performance Studies: The inclusion of performance studies demonstrating accuracy and precision when compared to a lab reference and using whole blood samples is standard for IVD devices to validate their analytical performance.

The definition of an IVD device generally includes instruments, reagents, and systems intended for use in the diagnosis of disease or other conditions, including a determination of the state of health, in order to cure, mitigate, treat, or prevent disease or its sequelae. The CoaguChek XS Plus System fits this definition by providing information about a patient's coagulation status (PT/INR) to manage their warfarin therapy, which is a treatment for a medical condition.

N/A

Intended Use / Indications for Use

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

Product codes

GJS

Device Description

The CoaguChek XS Plus system is a portable coagulation monitoring system to monitor prothrombin time (PT) in patients receiving oral anticoagulant therapy. The system uses the amperometric detection of thrombin in the blood sample. A test strip is used to determine a PT value from 10 uL of whole blood. Onboard quality control is available on every test strip and the system also features an optional external quality control material (CoaguChek XS PT Control).

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

Accuracy compared to lab reference:
Venous Blood: N = 811, Slope = 1.090, Intercept = -0.2, Correlation = 0.974
Capillary Blood: N = 822, Slope = 1.075, Intercept = -0.1, Correlation = 0.972

Whole Blood Precision:
Venous Blood: N = 399, Mean INR = 2.32, SD = 0.046, CV = 2.00
Capillary Blood: N = 399, Mean INR = 2.26, SD = 0.077, CV = 3.39

Control Precision:
Level 1: N = 538, Mean INR = 1.18, SD = 0.04, CV = 3.37
Level 2: N = 535, Mean INR = 2.95, SD = 0.12, CV = 4.10

Key Metrics

Accuracy, Precision

Predicate Device(s)

K060978

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).

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K07104/

MAY 1 1 2007

510(k) Summary – CoaguChek XS Plus System

IntroductionAccording to the requirements of 21 CFR 807.92, the following information provides sufficient detail to understand the basis for a determination of substantial equivalence
Submitter name, address, contactRoche Diagnostics
9115 Hague Rd
Indianapolis IN 46250
(317) 521-3723
Contact person: Theresa A. Bush
Date prepared: April 11, 2007
Device NameProprietary name: CoaguChek® XS Plus System
Common name: Prothrombin time test
Classification name: Prothrombin time test
Device DescriptionThe CoaguChek XS Plus system is a portable coagulation monitoring system to monitor prothrombin time (PT) in patients receiving oral anticoagulant therapy. The system uses the amperometric detection of thrombin in the blood sample. A test strip is used to determine a PT value from 10 uL of whole blood. Onboard quality control is available on every test strip and the system also features an optional external quality control material (CoaguChek XS PT Control).
Intended useIntended for use by professional healthcare providers for quantitative prothrombin time testing for the monitoring of warfarin therapy. The system uses fresh capillary or non-anticoagulated venous whole blood.
Predicate DeviceThe Roche Diagnostics CoaguChek XS Plus System is substantially equivalent to to the previously cleared CoaguChek XS System (K060978).
SimilaritiesThe table below indicates the similarities between the CoaguChek XS Plus System and the CoaguChek XS System.

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| Feature/Claim | Modified Device: CoaguChek XS Plus | Predicate Device:
CoaguChek XS |
|---------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------|
| | General features | |
| Intended Use | Intended for use by professional healthcare
providers for quantitative prothrombin
time testing for the monitoring of warfarin
therapy. The system uses fresh capillary or
non-anticoagulated venous whole blood. | Same |
| Fundamental Technology | Electrochemical technology with
amperometric (electric current) detection
of thrombin activity | Same |
| Sample Type | Capillary whole blood or non-
anticoagulated venous whole blood | Same |
| Sample Volume | The blood drop must be a minimum of 10
µL | Same |
| Test Strip | CoaguChek XS PT Test
Reference number: 04625315160 | Same |
| Onboard control | Built into every test strip | Same |
| External quality control | CoaguChek XS PT Controls are available
as optional external controls | Same |
| | System Performance Characteristics | |
| Hematocrit Range | Hematocrit ranges between 25 – 55% do
not significantly affect test results | Same |
| Bilirubin | Bilirubin up to 30 mg/dL have no
significant effect on test results | Same |
| Triglyceride | Lipemic samples containing up to 500
mg/dL of triglycerides do not significantly
effect on test results | Same |
| Hemolysis | Hemolysis up to 1000mg/dL have no
significant effect on test results | Same |
| Heparin | Test results are unaffected by heparin
concentrations up to 0.8 U/mL. | Same |
| Low Molecular Weight
Heparin | The CoaguChek XS PT Test is insensitive
to low molecular weight heparins
(LMWH) up to 2 IU anti-factor Xa
activity/mL | Same |
| Measuring Range | 0.8 to 8.0 INR | Same |

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ModificationsThe following table lists the modified features of the CoaguChek XS Plus System.
-------------------------------------------------------------------------------------------------

| Feature/Claim | Modified Device: CoaguChek
XS Plus System | Predicate Device: CoaguChek
XS System |
|----------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| General features | | |
| Strip lot identification | Handled automatically by meter
using barcode reader and
information on test strip code chip | Handled manually |
| Memory Capacity | • 500 test results with date, time,
patient ID, operator ID
• 60 code chip records | • 100 test results with
date and time
• No code chip records
maintained |
| Quality Control (QC)
Lockout
Control Target values | If QC results fail, the operator is
locked from performing a test.
Lot-specific target values
provided on QC code chip | Not available
No QC code chip; lot -specific
values found on value sheet |
| Hardware modifications and features | | |
| Components | Three:
• Handheld Basic Module
(HBM)
• Measurement Module
(MM)
• Barcode Reader (BR) | One:
• Measurement Module
(MM) |
| Handheld Basic Module
(HBM) | An additional component which
provides the power management
of the AC-adapter or rechargeable
batteries and houses all the data
management features including
• IR module for data
transfer to external device
• Beeper
• Codekey connectors (for
test strip and control)
• On/off button | No HBM.
Peripheral functions located
directly on MM
• IR module is on MM
• Beeper is on MM
• Codekey connector found on
MM
• on/off button on MM |
| Measurement Module
(MM) | Converts raw signals from test strip into final PT result.
Same measurement software as XS, ensuring same test processes and result Strip chamber cover with modified blue cover Same printed circuit board with differences in assembled components for peripheral functions: Additional connector to HBM Beeper, codekey connectors, IR module and on/off buttons are on the HBM, not on the MM Set and memory buttons are accessible via touch screen; not as separate keys | Contains measurement software for generation of PT result from raw signal Contains strip chamber cover Houses peripheral functions such as beeper, code chip connector, IR-module, and three buttons (on/off, memory, setup) |
| Barcode Reader (BR) | Separate board with camera and electronics; enables automatic Strip Lot Identification by reading 2D barcode on test strip and comparing to codekey | No bar code reader |
| Software modifications and features | | |
| Measurement oftware | IDENTICAL to measurement software on XS | Converts raw signal into PT result |
| Barcode reader software | Software communicates with barcode reader and responds to barcodes | No barcode reader |
| Code chip (aka codekey) software | Codekey information stored in data manager; transferred to measurement manager Codekey for liquid QC | General codekey handling in measurement module.
No codekey for liquid QC. |
| Errorhandling | Handled in data manager with additional features | Handled in measurement module |
| Connection to Host | Infrared via POCT/ICI communication | Infrared via ICI communication |
| Infrared communication
switch | Can switch between POCT and
ICI | Not present |
| QC handling | QC measurement, results,
lockouts handled in data manager | Not handled in software |
| Patient ID | Software allows for entry of a
Patient ID | Not available |
| User ID | Software allows for the entry of a
User (Operator) ID | Not available |
| Administrator ID | Software allows for the entry of
an Administrator ID | Not available |
| User Interface | Text-enhanced icon-based user
interface | Icon-based user interface |
| Language | 12 languages can be selected | Not available |
| HBM software features | • Boot process and software updates
• Driver for communication between internal components
• Power management
• Display software
• Driver for clock and interrupt
• Watchdog for configuration, powermodes | No HBM |
| System Performance Characteristics | | |
| Accuracy compared to
lab reference | Venous Blood:
N = 811
Slope = 1.090
Intercept = -0.2
Correlation = 0.974 | Venous Blood:
N = 710
Slope = 1.034
Intercept = -0.02
Correlation = 0.974

Capillary Blood:
N = 700
Slope = 1.006
Intercept = 0.032
Correlation = 0.971 |
| | Capillary Blood:
N = 822
Slope = 1.075
Intercept = -0.1
Correlation = 0.972 | |
| Whole Blood Precision | Venous Blood:
N = 399
Mean INR = 2.32
SD = 0.046
CV = 2.00 | Venous Blood:
N = 357
Mean INR = 2.59
SD = 0.06
CV = 2.42 |
| | Capillary Blood:
N = 399
Mean INR = 2.26
SD = 0.077
CV = 3.39 | Capillary Blood:
N = 344
Mean INR = 2.59
SD = 0.11
CV = 4.35 |
| Control Precision | Level 1
N = 538
Mean INR = 1.18
SD = 0.04
CV = 3.37 | Level 1
N = 54
Mean INR = 1.20
SD = 0.01
CV = 1.1 |
| | Level 2
N = 535
Mean INR = 2.95
SD = 0.12
CV = 4.10 | Level 2
N = 54
Mean INR = 2.49
SD = 0.06
CV = 2.3 |

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Image /page/6/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized depiction of an eagle or bird-like figure with three curved lines representing its wings or body. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular fashion around the bird-like figure.

Food and Drug Administration 2098 Gaither Road Rockville MD 20850

MAY 1 1 2007

Roche Diagnostics C/O Theresa A. Bush, PhD, RAC 9115 Hague Road Indianapolis, Indiana 46250

Re: K071041

Trade/Device Name: CoaguChek® XS Plus System Regulation Number: 21 CFR 864.7750 Regulation Name: Prothrombin time test Regulatory Class: Class II Product Code: GJS Dated: April 11, 2007 Received: April 12, 2007

Dear Dr. Bush:

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

7

Page 2 - Theresa A. Bush, PhD, RAC

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, or questions on the promotion and advertising of your device, please contact the Office of In Vitro Diagnostic Device Evaluation and Safety at (301) 594-3084. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division 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,

Sincerely yours,

Robert Zastocki

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

Enclosure

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Indications for Use

Ko 71041 510(k) Number (if known):

Device Name: CoaguChek XS Plus System

Indications For Use:

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

Prescription Use XXX (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 In Vitro Diagnostic Devices (OIVD)

Division Sign-Off

Office of In Vitro Diagnostic Device Evaluation and Safety

510(k) K071041

Page 1 of of 1 -

Special 510(k) for CoaguChek XS Plus System. Confidential

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