Reproductibilité et interchangeabilité du Thromboélastographe®, Sonoclot® et du temps de coagulation activé (Hémochron®), en chirurgie cardiaque

Abstract

O Ob bj je ec ct ti if f : : Malgré une utilisation courante, la reproductibilité des mesures du Thromboélastographe® (TEG), du Sonoclot® (SCT), et de l Hémochron® mesurant le temps de coagulation activé avec célite ou kaolin (ACT-C et ACT-K), a été peu étudiée dans les conditions réelles d utilisation. La présente étude évalue la reproductibilité de ces mesures, et la possibilité de substituer l ACT-C par un des autres tests. Methods: Blood samples collected from 20 volunteers and 21 patients undergoing myocardial revascularization were analyzed in the two channels of the TEG, in two SCT and four Hemochron® analyzers. The overall of TEG and SCT coagulation profiles were analyzed by a computerized TEG and an experienced observer respectively. The variation rate (V%) was calculated for each variable. The ability of ACT-K and SCT to substitute for ACT-C under different clinical conditions was evaluated.Results: ACT-C and ACT-K V% ranged between 5.6% and 10.8% and between 6.7% and 12.4% respectively. TEG and SCT V% ranged between 3.1% and 9.5% and between 5.8% and 33.6% respectively, according to different conditions and parameters. In volunteers and nonheparinized patients, the ACT-C and ACT-K were interchangeable. No other test can substitute for the ACT-C when patients are heparinized during cardiopulmonary bypass (CPB). Conclusions:In the clinical conditions of use, on-site hemostasis monitoring devices providing the most reproducible measurements are, in decreasing order, the TEG, the Hemochron® and the SCT. In heparinized patients and during CPB, results from different tests are not interchangeable, stressing the importance of establishing appropriate instrument-specific values for monitoring anticoagulation during cardiac surgery.

Platelet function monitoring with the Sonoclot analyzer after in vitro tirofiban and heparin administration

“…Sonoclot analyzer has even demonstrated a precision close to that of thrombelastography. 26 In the present study we were able to show reliable results with reproducibility comparable with that of turbidimetric platelet aggregometry. One possible explanation for this better performance might be the different tests used in our study (GB and hepGB) compared with those used in earlier publications (predominantly testing of celiteactivated blood samples).…”

Coagulation Monitoring: Current Techniques and Clinical Use of Viscoelastic Point-of-Care Coagulation Devices

“…Additionally, studies showed poor reproducibility of some of the measured parameters, especially CR and PF (22,23). However, others found the Sonoclot® Analyzer to be valuable and reliable in patients undergoing cardiac surgical procedures (24,25) and the Sonoclot® Analyzer has even demonstrated a precision close to that of thrombelastography (26). In more recent studies, test variability of ACT values determined by Sonoclot® were comparable to other established ACT analyzers (8-9% on average) (15)(16)(17)(18).…”

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

“…Four studies were excluded because of insufficient data to judge the study design. [149][150][151][152] In the trial by Agarwal et al,…”