Messung der Thrombozytenfunktion mit Point-of-Care-Methoden

Görlinger, Klaus; Jámbor, Csilla; Dirkmann, Daniel; Dusse, Fabian; Hanke, Alexander; Adamzik, Michael; Hartmann, Matthias; Philipp, Sebastian; Weber, Artur‐Aron; Rahe‐Meyer, Niels

doi:10.1007/s00059-008-3130-4

Cited by 32 publications

(11 citation statements)

References 54 publications

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“…The following commercially available tests were performed following the manufacturer's instructions: ExTEM (extrinsically activation by tissue factor) and FibTEM (extrinsically activation by tissue factor with addition of Cytochalasin D to inhibit platelet function and display fibrin polymerization only - all tests Pentapharm, Munich, Germany). Since maximum clot firmness (MCF) in whole blood coagulation is mainly determined by platelet function and fibrin polymerization, while clotting times (CT) are dependent on the speed of thrombin generation by clotting factors [10] the chosen parameters were: CT quantifying the time from beginning of the reaction until start of clot formation and MCF indicating clot stability at its highest degree.…”

Section: Methodsmentioning

confidence: 99%

In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch

Hanke

Maschler

Schöchl³

et al. 2011

Scand J Trauma Resusc Emerg Med

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BackgroundHypertonic saline hydroxyethyl starch (HH) has been recommended for first line treatment of hemorrhagic shock. Its effects on coagulation are unclear. We studied in vitro effects of HH dilution on whole blood coagulation and platelet function. Furthermore 7.2% hypertonic saline, 6% hydroxyethylstarch (as ingredients of HH), and 0.9% saline solution (as control) were tested in comparable dilutions to estimate specific component effects of HH on coagulation.MethodsThe study was designed as experimental non-randomized comparative in vitro study. Following institutional review board approval and informed consent blood samples were taken from 10 healthy volunteers and diluted in vitro with either HH (HyperHaes®, Fresenius Kabi, Germany), hypertonic saline (HT, 7.2% NaCl), hydroxyethylstarch (HS, HAES6%, Fresenius Kabi, Germany) or NaCl 0.9% (ISO) in a proportion of 5%, 10%, 20% and 40%. Coagulation was studied in whole blood by rotation thrombelastometry (ROTEM) after thromboplastin activation without (ExTEM) and with inhibition of thrombocyte function by cytochalasin D (FibTEM), the latter was performed to determine fibrin polymerisation alone. Values are expressed as maximal clot firmness (MCF, [mm]) and clotting time (CT, [s]). Platelet aggregation was determined by impedance aggregrometry (Multiplate) after activation with thrombin receptor-activating peptide 6 (TRAP) and quantified by the area under the aggregation curve (AUC [aggregation units (AU)/min]). Scanning electron microscopy was performed to evaluate HyperHaes induced cell shape changes of thrombocytes.Statistics: 2-way ANOVA for repeated measurements, Bonferroni post hoc test, p < 0.01.ResultsDilution impaired whole blood coagulation and thrombocyte aggregation in all dilutions in a dose dependent fashion. In contrast to dilution with ISO and HS, respectively, dilution with HH as well as HT almost abolished coagulation (MCFExTEM from 57.3 ± 4.9 mm (native) to 1.7 ± 2.2 mm (HH 40% dilution; p < 0.0001) and to 6.6 ± 3.4 mm (HT 40% dilution; p < 0.0001) and thrombocyte aggregation (AUC from 1067 ± 234 AU/mm (native) to 14.5 ± 12.5 AU/mm (HH 40% dilution; p < 0.0001) and to 20.4 ± 10.4 AU/min (HT 40% dilution; p < 0.0001) without differences between HH and HT (MCF: p = 0.452; AUC: p = 0.449).ConclusionsHH impairs platelet function during in vitro dilution already at 5% dilution. Impairment of whole blood coagulation is significant after 10% dilution or more. This effect can be pinpointed to the platelet function impairing hypertonic saline component and to a lesser extend to fibrin polymerization inhibition by the colloid component or dilution effects.Accordingly, repeated administration and overdosage should be avoided.

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Section: Methodsmentioning

confidence: 99%

In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch

Hanke

Maschler

Schöchl³

et al. 2011

Scand J Trauma Resusc Emerg Med

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“…A new device for the measurement of platelet function using whole blood impedance aggregometry as the principle is available [15]. The Multiplate ® device (Verum Diagnostica, Munich, Germany) allows the simultaneous measurement of whole blood samples with five activators and the computerized design makes a point of care measurement possible.…”

Section: Introductionmentioning

confidence: 99%

Whole blood impedance aggregometry as a biomarker for the diagnosis and prognosis of severe sepsis

et al. 2012

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IntroductionSepsis leads to an activation of the immune system and hemostatis. However, studies on platelet aggregation in severe sepsis using impedance aggregometry have not been performed and the diagnostic and prognostic capabilities are unknown. In the present study we hypothesized that impedance aggregometry findings might serve as a biomarker for the diagnosis and prognosis of severe sepsis.MethodsEighty patients with severe sepsis and 50 postoperative patients were included in the prospective observational study. Platelet function was determined at the first day of severe sepsis and surgery, respectively, using impedance aggregometry (Multiplate®). Moreover, platelet count, procalcitonin, interleukin 6, C-reactive protein and 30-day mortality were determined.ResultsCompared to postoperative patients, platelet aggregation was significantly reduced in patients with severe sepsis (collagen-test: 70.8 (44.4, 83.2) arbitrary units (A.U.) vs. 26.8 (12.7, 45.8) A.U.; P <0.001; median and quartiles). Furthermore, marked differences in platelet function were observed in survivors and non-survivors of severe sepsis (collagen-test: 33.4 (10.9, 48.8) A.U. vs. 12.4 (6.5, 25.0) A.U.; P = 0.001). Kaplan-Meier analysis demonstrated that higher platelet function was associated with a mortality of 10%, while mortality was 40% when platelet function was low (collagen-test; P = 0.002). The odds ratio was 6.0. In both univariate and multivariate analyses (including procalcitonin, IL6, C-reactive protein and platelet count) impedance aggregometry using collagen as the activator proved to be the best and an independent predictor for the diagnosis and prognosis of severe sepsis in critical illness.ConclusionsIn severe sepsis, impedance aggregometry allows better prediction of diagnosis and survival than conventional biomarkers and platelet count.

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“…Dazu kommen noch Medikamenteninteraktionen und die neuen oralen Antikoagulanzien vom Typ der direkten Xa-und Thrombininhibitoren, die im Rahmen der Zulassung zur Antikoagulation bei Vorhofflimmern immer weitere Verbreitung finden werden [10,11]. Zudem entziehen sich die Thrombozytenaggregationshemmer und die neuen oralen Antikoagulanzien weitestgehend dem Monitoring durch konventionelle Labormethoden (Quick/INR-Test, aPTT-, Fibrinogen-und Thrombozytenzahlbestimmung), die bisher den Standard der perioperativen Gerinnungsdiagnostik darstellen [8,10,11]. In diesem Zusammenhang wird schon seit längerer Zeit die präopera-tive Durchführung einer standardisierten Blutungsanamnese empfohlen [15] …”

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Messung der Thrombozytenfunktion mit Point-of-Care-Methoden

Cited by 32 publications

References 54 publications

In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch

In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch

Whole blood impedance aggregometry as a biomarker for the diagnosis and prognosis of severe sepsis

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