scholarly journals Comparison of Standard Coagulation Testing with Thromboelastometry Tests in Cardiac Surgery

2019 ◽  
Vol 11 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Elham Khalaf- Adeli ◽  
Mostafa Alavi ◽  
Alireza Alizadeh-Ghavidel ◽  
Ali Akbar Pourfathollah
Keyword(s):  
Cardiac Surgery ◽  
Reference Range ◽  
Point Of Care ◽  
Valve Surgery ◽  
Limited Data ◽  
Point Of Care Test ◽  
Transfusion Requirements ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
Before And After

Introduction: According to the several evidences, using thromboelastometry as a point of care test canbe effective in reduction in blood loss and transfusion requirements in cardiac surgeries. However,there are limited data regarding to the comparison of thromboelastometry and the standard coagulationtests. In this study, we compared thromboelastometry and standard coagulation tests (PT, PTT andfibrinogen level) in patients under combined coronary-valve surgery. Methods: Forty adult patients who were under on-pump combined coronary-valve surgery wereincluded in this study. Thromboelastometry tests Fibtem, Intem, Extem and Heptem), along withstandard coagulation tests (PT, PTT and fibrinogen assay) were simultaneously performed in two timepoints, before and after the pump (pre-CPB and post-CPB, respectively). Results: A total of 80 blood samples were analyzed. There were no significant correlation between PTtest and the CT-Extem parameter as well as PTT and CT-Intem parameter either in pre-CPB and post-CPB (P > 0.05). On the contrary, fibrinogen level had high correlation with A10-Fibtem and A10-Extemin pre-PCB (P < 0.05). 82% of PT and 84% of PTT measurements were outside the reference range,while abnormal CT in Extem and Intem was observed in 17.9%. Conclusion: For management of bleeding, adequate perioperative haemostatic monitoring isindispensable during cardiac surgery. Standard coagulation tests are time consuming and cannot beinterchangeably used with thromboelastomety and relying on their results to decide whether bloodtransfusion is necessary, leads to the inappropriate transfusion.

Point-of-Care Coagulation Testing in Cardiac Surgery

2017 ◽  
Vol 43 (04) ◽  
pp. 386-396 ◽  
Author(s):  
Kenichi Tanaka ◽  
Daniel Bolliger
Keyword(s):  
Cardiac Surgery ◽  
Point Of Care ◽  
Postoperative Bleeding ◽  
Blood Platelet ◽  
Heparin Therapy ◽  
Bleeding Complications ◽  
Treatment Algorithms ◽  
Product Usage ◽  
Coagulation Testing ◽  
Coagulation Tests

AbstractBleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment decisions are time sensitive. Point-of-care (POC) testing has an advantage over standard laboratory tests for faster turn-around times, and timely decision on coagulation intervention(s). The most common POC coagulation testing is the activated clotting time (ACT), used to monitor heparin therapy while on cardiopulmonary bypass. Viscoelastic coagulation tests including thromboelastometry (ROTEM) and thromboelastography (TEG) have been recommended for the treatment of postoperative bleeding after cardiac surgery because the ROTEM/TEG-guided treatment algorithms reduced the use of blood products. Other POC tests are commercially available, but there is sparse evidence for their routine use in cardiac surgery. These devices include heparin management systems, POC prothrombin time and activated partial thromboplastin time, POC fibrinogen assay, and whole blood platelet function tests. There are multiple confounding elements and conditions associated with cardiac surgery, which can significantly alter test results. Anemia and thrombocytopenia are regularly associated with deviations in many POC devices. In summary, POC coagulation testing allows for rapid clinical decisions in hematological interventions, and, when used in conjunction with a proper transfusion algorithm, may reduce blood product usage, and potentially complications associated with blood transfusion.

Evaluation of a Novel Transfusion Algorithm Employing Point-of-care Coagulation Assays in Cardiac Surgery

2015 ◽  
Vol 122 (3) ◽  
pp. 560-570 ◽  
Author(s):  
Keyvan Karkouti ◽  
Stuart A. McCluskey ◽  
Jeannie Callum ◽  
John Freedman ◽  
Rita Selby ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Time Trends ◽  
Point Of Care ◽  
Interrupted Time Series ◽  
Blood Products ◽  
Interrupted Time Series Analysis ◽  
Point Of Care Testing ◽  
Coagulation Testing ◽  
Coagulation Tests ◽  
The Many

Abstract Background: Cardiac surgery requiring the use of cardiopulmonary bypass is frequently complicated by coagulopathic bleeding that, largely due to the shortcomings of conventional coagulation tests, is difficult to manage. This study evaluated a novel transfusion algorithm that uses point-of-care coagulation testing. Methods: Consecutive patients who underwent cardiac surgery with bypass at one hospital before (January 1, 2012 to January 6, 2013) and after (January 7, 2013 to December 13, 2013) institution of an algorithm that used the results of point-of-care testing (ROTEM®; Tem International GmBH, Munich, Germany; Plateletworks®; Helena Laboratories, Beaumont, TX) during bypass to guide management of coagulopathy were included. Pre- and postalgorithm outcomes were compared using interrupted time-series analysis to control for secular time trends and other confounders. Results: Pre- and postalgorithm groups included 1,311 and 1,170 patients, respectively. Transfusion rates for all blood products (except for cryoprecipitate, which did not change) were decreased after algorithm institution. After controlling for secular pre- and postalgorithm time trends and potential confounders, the posttransfusion odds ratios (95% CIs) for erythrocytes, platelets, and plasma were 0.50 (0.32 to 0.77), 0.22 (0.13 to 0.37), and 0.20 (0.12 to 0.34), respectively. There were no indications that the algorithm worsened any of the measured processes of care or outcomes. Conclusions: Institution of a transfusion algorithm based on point-of-care testing was associated with reduced transfusions. This suggests that the algorithm could improve the management of the many patients who develop coagulopathic bleeding after cardiac surgery. The generalizability of the findings needs to be confirmed.

Use of point-of-care test in identification of patients who can benefit from desmopressin during cardiac surgery: a randomised controlled trial

The Lancet ◽  
1999 ◽  
Vol 354 (9173) ◽  
pp. 106-110 ◽  
Author(s):  
George J Despotis ◽  
Vladimir Levine ◽  
Rao Saleem ◽  
Edward Spitznagel ◽  
J Heinrich Joist
Keyword(s):  
Cardiac Surgery ◽  
Randomised Controlled Trial ◽  
Point Of Care ◽  
Controlled Trial ◽  
Point Of Care Test ◽  
Randomised Controlled

Level of agreement between laboratory and point-of-care prothrombin time before and after cardiopulmonary bypass in cardiac surgery

2014 ◽  
Vol 133 (6) ◽  
pp. 1141-1144 ◽  
Author(s):  
Michael I. Meesters ◽  
Alexander B.A. Vonk ◽  
Emma K. van de Weerdt ◽  
Suzanne Kamminga ◽  
Christa Boer
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Prothrombin Time ◽  
Point Of Care ◽  
Before And After ◽  
Level Of Agreement

Use of Quantra point-of-care coagulation testing device for guiding transfusion in cardiac surgery

2018 ◽  
Vol 32 ◽  
pp. S56
Author(s):  
Wael Zghaibe ◽  
A.A. Klein ◽  
G. Blaudszun ◽  
K. Munting ◽  
M. Besser
Keyword(s):  
Cardiac Surgery ◽  
Point Of Care ◽  
Testing Device ◽  
Coagulation Testing

Point-of-Care Coagulation Tests Monitoring of Direct Oral Anticoagulants and Their Reversal Therapy: State of the Art

2017 ◽  
Vol 43 (04) ◽  
pp. 423-432 ◽  
Author(s):  
Paolo Bianchi ◽  
Marco Ranucci ◽  
Ekaterina Baryshnikova ◽  
Giacomo Iapichino
Keyword(s):  
Point Of Care ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Plasma Concentrations ◽  
Urgent Surgery ◽  
Drug Plasma Concentrations ◽  
Drug Plasma ◽  
Coagulation Tests ◽  
Before And After

AbstractDirect oral anticoagulants (DOACs) exert similar anticoagulant effects to vitamin K antagonists and are increasingly used worldwide. Nevertheless, an evidence-based approach to patients receiving DOACs when any unplanned urgent surgery or bleeding (either spontaneous or traumatic) occurs is still missing. In this review, we investigate the role of point-of-care coagulation tests when other, more specific tests are not available. Indeed, thromboelastography and activated clotting time can detect dabigatran-induced coagulopathy, while their accuracy is limited for apixaban and rivaroxaban, mostly in cases of low drug plasma concentrations. These tests can also be used to guide the reversal of DOAC-induced coagulopathy providing a quick, before-and-after picture in case of therapeutic use of hemostatic compounds.

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