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Semin Thromb Hemost
DOI: 10.1055/s-0044-1787661
Review Article

Hemostasis Testing in the Emergency Department: A Narrative Review

Henri Thonon
1   Emergency Department, Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Yvoir, Belgium
,
Michael Van Nieuwenhove
2   Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Réseau Santé Louvain, Belgium
,
Jecko Thachil
3   Department of Haematology, Manchester University Hospitals, Manchester, United Kingdom
,
Giuseppe Lippi
4   Section of Clinical Biochemistry, University of Verona, Verona, Italy
,
Michael Hardy
5   Department of Anesthesiology, Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Yvoir, Belgium
,
François Mullier
6   Université catholique de Louvain, CHU UCL Namur, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), Hematology Laboratory, Yvoir, Belgium
7   Institut de Recherche Expérimentale et Clinique (IREC), Pôle Mont, Université catholique de Louvain (UCLouvain), Yvoir, Belgium
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Abstract

Routine laboratory screening is typically performed at initial evaluation of the vast majority of presentations to the emergency department (ED). These laboratory results are crucial to the diagnostic process, as they may influence up to 70% of clinical decisions. However, despite the usefulness of biological assessments, many tests performed are inappropriate or of doubtful clinical relevance. This overutilization rate of laboratory testing in hospitals, which represents a significant medical–economic burden, ranges from 20 to 67%, with coagulation tests at the top of the list. While reviews frequently focus on nonintensive care units, there are few published assessments of emergency-specific interventions or guidelines/guidance to date. The aim of this review is to highlight current recommendations for hemostasis evaluation in the emergency setting with a specific analysis of common situations leading to ED admissions, such as suspected venous thrombosis or severe bleeding. We revisit the evidence related to the assessment of patient's hemostatic capacity based on comprehensive history taking and physical examination as well as best practice recommendations for blood sample collection to ensure the reliability of results. This review also includes an examination of various currently available point of care tests and a comprehensive discussion on indications, limitations, and interpretation of these tests.

Keywords

emergency - coagulopathy - POCT - direct oral anticoagulant - viscoelastic testing - APTT - thrombosis - appropriate prescription - sustainability


Publication History

Article published online:
19 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers
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