Point‐of‐care monitoring of haemostasis

Abstract

SummaryRecent research in the management of haemorrhage has led to several changes in clinical practice. Evidence is accumulating that point‐of‐care testing results in fewer transfusions, improved patient outcomes, and reduced hospital costs. However, there is still insufficient high quality evidence to support transfusion guidelines and algorithms based on point‐of‐care tests alone, and more robust studies are needed. The implementation of point‐of‐care testing requires institutional support and senior clinical leadership to realise the benefits, with educational programmes, audit, and feedback regarding transfusion practice. A change in philosophy is required, from performing testing only when there is an obvious bleeding problem, towards the concept of routinely monitoring high‐risk patients throughout the surgical procedure. This informs clinical practice, establishes normal ranges for that population, identifies patients at risk and allows early identification and treatment of evolving coagulopathy.

Thromboelastometry analysis of thrombocytopenic dengue patients: a cross-sectional study

“…Fibrinogen, the factor I of coagulation system, is the most important numerically and functionally coagulation factor [12, 22]. Fibrinogen represents approximately ninety percent of the total amount of plasmatic coagulation factors and it is the first coagulation factor to fall below a critical value during bleeding and hemodilution [10, 20, 22, 23].…”

“…Viscoelastic tests allow early and individualized coagulation management in different scenarios, such as in trauma [26, 27], liver transplantation [13, 28], cardiac [15, 28] and neurologic surgeries [16, 29], post-partum hemorrhage [12, 27] and in critically ill patients [22, 26, 28]. Nevertheless, dengue treatment is based mainly on supportive care with fluids and electrolytes [2, 4, 30, 31].…”

“…Rotational thromboelastometry (ROTEM®) is a point of care test that promptly provides (5–30 min) information about the dynamics of clot formation, stabilization and dissolution, reflecting the in vivo hemostasis at the bedside [12]. ROTEM provides more clinically useful and reliable information than the conventional coagulation tests in critically ill patients [13, 14], yielding a graphical presentation of fibrin polymerization process, involving fibrinogen and platelet function, and fibrinolysis [13].…”

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

“…25 We hypothesised that any additional benefit would be attributable to the added value of a test that can detect the effects of antiplatelet drugs and discriminate between platelet dysfunction and fibrin deficiency. 79 Finally, if coagulopathic haemorrhage has a causal relationship with adverse clinical outcomes, it is sensible to suggest that POC tests that improve clinical prediction for bleeding may also have the potential to predict adverse clinical outcomes. This has not previously been investigated.…”

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

“…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]. For this reason they are utilized to guide the clinical management of acute coagulopathy that follows trauma and hemorrhages, including obstetric cases [39][40][41]. To our knowledge however there are no studies that document the utilization or the appropriateness of POC coagulation tests in resource-limited settings.…”