Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery

Pierre Toulon; Yves Ozier; Annick Ankri; Marie-Hélène Fléron; Geneviève Leroux; Charles Marc Samama

doi:10.1160/TH08-06-0383

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 101(02): 394-401
DOI: 10.1160/TH08-06-0383

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery

A multicenter study

Pierre Toulon

¹Université de Nice-Sophia Antipolis, Faculté de Médecine, Service d’Hématologie Biologique, Nice, France

²Service d’Hématologie Biologique, Université Paris Descartes, Hôpital Cochin, Paris, France

,

Yves Ozier

³Département d’Anesthésie-Réanimation, Université Paris Descartes, Hôpital Cochin, Paris, France

,

Annick Ankri

⁴Service d’Hématologie Biologique, Hôpital La-Pitié-Salpétrière, Paris, France

,

Marie-Hélène Fléron

⁵Département d’AnesthésieRéanimation, Hôpital La-Pitié-Salpétrière, Paris, France

,

Geneviève Leroux

⁶Laboratoire d’Hématologie, Hôpital Avicenne, Bobigny, France

,

Charles Marc Samama

⁷Département d’Anesthésie-Réanimation, Hôpital Avicenne, Bobigny, France

› Author Affiliations

Abstract

Summary

Delay in collecting coagulation test results from a central laboratory is one of the critical issues to efficiently control haemostasis during surgery. The aim of this multicenter study was to compare the performance of a point-of-care (POC) device (CoaguChek^™ Pro DM) with the central laboratory-based coagulation testing during haemorrhagic surgery. For this purpose, 93 patients undergoing major surgical procedure were prospectively included in three centers. Blood was drawn from all patients before surgical incision and from most patients during surgical procedure after a blood loss of 25% or more was observed. When expressed in activity percentage, POC-based prothrombin time (PT) was in good agreement with central laboratory test result with coefficient of correlation in the range from 0.711 to 0.960 in the three centers. Comparison was less conclusive when PT was expressed in seconds or as the patient-to-control ratio and for activated partial thromboplastin time, with significantly shorter clotting times and lower ratios obtained on the POC device. On-site PT (in activity percentage) monitoring would have induced no significant change in fresh frozen plasma (FFP) transfusion in patients when compared to central laboratory monitoring. Test results were obtained in less than 5 minutes when performed using the POC device versus a median turnaround time of 88 minutes (range: 29–235 minutes) when blood collection tubes were sent to the central laboratory. These results suggest that, in providing a rapid answer, POC-based monitoring of PT (in percentage) using the CoaguChek device could be validly used in patients undergoing haemorrhagic surgical procedures.

Keywords

Point of care - coagulation - testing - surgery - haemorrhage - transfusion - fresh frozen plasma

Full Text

References

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