Point-of-care coagulation testing and transfusion algorithms

Abstract

Patients with cardiovascular disease have an array of haemostasis disorders that predispose to the development of thrombotic and embolic disease states. These patients are often maintained on anti-thrombotic medication to prevent adverse cardiovascular events. Patients undergoing cardiac surgery also have haemostatic disorders that include their intrinsic disease state, adjunctive medication, and the coagulation disturbances induced by cardiopulmonary bypass. The following review introduces the monitors that are available for monitoring perioperative coagulation, with an emphasis on cardiovascular surgery. Heparin monitors, platelet function monitors for use in transfusion algorithms, and monitoring anti-platelet drugs will be discussed.

The rationale for platelet transfusion during cardiopulmonary bypass: an observational study

“…Concurrent with the results of our and other observational studies, physicians identified bleeding as the most important factor in influencing their decision to transfuse platelets, which coincides with the belief that microvascular bleeding is thought to be predominantly secondary to platelet dysfunction 2,16 and consistent with recommendations regarding when to transfuse platelets. 17 This finding supports the need for point-of-care tests to identify whether bleeding is mainly secondary to thrombocytopathy, particularly as physicians identified the *P = 0.0099 when compared with 101-150 9 10 9 L -1 preoperative platelet count; **P \ 0.0001 when compared with no platelet transfusion.…”

Point of Care Testing and Transfusion Safety in Resource Limited Settings: A Review

“…Their main uses are the monitoring of vitamin-K antagonist oral anticoagulants, the assessment of platelet function, in particular in patients undergoing anti-platelets therapy, as well as the rapid evaluation of clotting function in bleeding patients during surgery and in emergency settings [33][34][35][36][37]. Out of these the viscoelastometric POCT devices are particularly useful in giving quick information on all the main phases and components of clot formation, including fibrinogen concentration, platelet activity and fibrinolysis [38].…”

Logistics of Massive Transfusions

“…No matter what laboratory monitoring is chosen, there needs to be an effective way to communicate the lab findings to those in charge Modified from Stahel et al, 20 Enriquez et al, 22 and Avidan et al 23 of running the MTP and to record the results. A simple, but effective, method is to keep a running flow chart of laboratories in a highly visible location.…”