Basisalgorithmus für „Point-of-Care“ basierte Hämotherapie

Abstract

During perioperative treatment of coagulopathic patients the so-called Point-of-Care (POC) analyses enable more rapidly available and more comprehensive hemostatic analyses compared to routinely performed conventional coagulation testing, such as activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen concentration and platelet count. In this review article a hemotherapy algorithm is presented which is based on viscoelastic and aggregometric POC measurements. The algorithm was designed double sided and consists of a general and a special part. The general part contains boxes and fields for sociodemographic data and gives general recommendations for coagulation management and therapy specifications for particular patient collectives and presents proposals for emergency reversal of anticoagulation therapy. The special part refers to basic physiological conditions for hemostasis and asks for measurement results of clot initiation, clot firmness, clot stability and platelet function analyses. Reference values were defined for each parameter and therapeutic options are presented. In cases of persistent coagulopathy despite algorithm-conform therapy, the algorithm could be run through once again. Finally, the algorithm presents therapeutic options for an ultima ratio therapy approach.

Rotational Thromboelastometry for Assessing Bleeding Complications and Factor XIII Deficiency in Cardiac Surgery Patients

“…3 Randomized trials have proven that point-of-care (POC)-based hemotherapy results in less blood loss and a lower transfusion rate than treatments based on the results of conventional laboratory analyses. 4–10…”

Update on point-of-care-based coagulation treatment

“…-methoden ist aus Sicht der Autoren ein Update des vor über 10 Jahren vorgestellten Algorithmus, der von Weber et al. in dieser Zeitschrift publiziert wurde, erforderlich [ 32 ]. Ziel dieses Artikels ist es, einen Überblick sowohl über die aktuell verfügbaren VET-Geräte als auch über die dazugehörigen Reagenzien zu vermitteln.…”

Platelet Function Disturbance During Veno-Venous ECMO in ARDS Patients Assessed by Multiple Electrode Aggregometry—A Prospective, Observational Cohort Study

“…In recent years, the understanding has grown that monitoring of platelet function is much more important for the evaluation of a bleeding event than the mere analysis of platelet number. The availability of multiple electrode aggregometry (MEA) as a point-of-care device for the bedside evaluation of platelet function from whole blood has led to its widespread use and to the implementation of MEA in algorithm-based treatment of hemorrhage [10,11]. However, it is unclear to which extent results from studies using MEA to evaluate the effects of short-term extracorporeal circulation, such as cardiopulmonary bypass, on platelet function, can be extrapolated on the effects during long-term extracorporeal circulation as in vvECMO therapy [9,12].…”