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DOI: 10.1055/s-0035-1544184
Point-of-Care Testing in Critically Ill Patients
Publication History
Publication Date:
22 January 2015 (online)
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Abstract
Point-of-care (POC) testing in hemostasis has experienced a significant increase in the spectrum of available tests and the number of tests performed. Short turn-around time and observation of rapid changes in test results are facilitated. The quality control process in POC testing must encompass a preanalytic (collection), analytic (measurement), and postanalytic (clinical response) phase. Erroneous interpretation of findings and difficult quality controls can outweigh the advantages of POC testing.
Only a limited number of hemostatic POC tests have proven useful so far: prothrombin time POC—monitoring of oral vitamin K antagonists; activated clotting time POC—monitoring of high-dose heparin therapy; platelet function analyzer (PFA; Siemens, Marburg, Germany) closure time (CT)—detection of von Willebrand disease and severe platelet function defects; whole blood aggregometry (WBA) Multiplate (Roche Diagnostics, Rotkreuz, Switzerland), and the VerifyNow system (Accumetrics, San Diego, CA)—detection of platelet dysfunction due to antiplatelet drugs; thromboelastography—continuous observation of clot formation and fibrinolysis. The use of various agonists in WBA and thromboelastography (TEG) requires some expertise. In experienced hands the PFA CT and WBA and TEG are recommended combinations.
Application of POC testing depends strictly on whether it improves medical care and patient outcome. More POC test systems are in the research pipeline, but only a few will resist the ravages of time.
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References
- 1 Briggs C, Guthrie D, Hyde K , et al; British Committee for Standards in Haematology General Haematology Task Force. Guidelines for point-of-care testing: haematology. Br J Haematol 2008; 142 (6) 904-915
- 2 Görlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA, Schöchl H. Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy. Transfus Med Hemother 2012; 39 (2) 104-113
- 3 Haas T, Spielmann N, Mauch J, Speer O, Schmugge M, Weiss M. Reproducibility of thrombelastometry (ROTEM®): point-of-care versus hospital laboratory performance. Scand J Clin Lab Invest 2012; 72 (4) 313-317
- 4 Briggs C, Carter J, Lee SH, Sandhaus L, Simon-Lopez R, Vives Corrons JL ; International Council for Standardization in Haematology (ICSH). ICSH Guideline for worldwide point-of-care testing in haematology with special reference to the complete blood count. Int J Lab Hematol 2008; 30 (2) 105-116
- 5 Dempfle CE, Borggrefe M. Point of care coagulation tests in critically ill patients. Semin Thromb Hemost 2008; 34 (5) 445-450
- 6 Kozek-Langenecker SA, Afshari A, Albaladejo P , et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2013; 30 (6) 270-382
- 7 Theusinger OM, Levy JH. Point of care devices for assessing bleeding and coagulation in the trauma patient. Anesthesiol Clin 2013; 31 (1) 55-65
- 8 Kitchen DP, Kitchen S, Jennings I , et al. Point of Care INR testing devices: performance of the Roche CoaguChek XS and XS Plus in the UK NEQAS BC external quality assessment programme for healthcare professionals: four years' experience. J Clin Pathol 2012; 65 (12) 1119-1123
- 9 Kitchen DP, Kitchen S, Jennings I, Woods T, Walker I. Quality assessment in point-of-care coagulation testing. Semin Thromb Hemost 2008; 34 (7) 647-653
- 10 Haas T, Fries D, Tanaka KA, Asmis L, Curry NS, Schöchl H. Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence?. Br J Anaesth 2014;
- 11 Gauss T, Hamada S, Jurcisin I , et al. Limits of agreement between measures obtained from standard laboratory and the point-of-care device Hemochron Signature Elite(R) during acute haemorrhage. Br J Anaesth 2014; 112 (3) 514-520
- 12 Meesters MI, Vonk AB, van de Weerdt EK, Kamminga S, Boer C. Level of agreement between laboratory and point-of-care prothrombin time before and after cardiopulmonary bypass in cardiac surgery. Thromb Res 2014; 133 (6) 1141-1144
- 13 Dzik WH. Predicting hemorrhage using preoperative coagulation screening assays. Curr Hematol Rep 2004; 3 (5) 324-330
- 14 Despotis GJ, Gravlee G, Filos K, Levy J. Anticoagulation monitoring during cardiac surgery: a review of current and emerging techniques. Anesthesiology 1999; 91 (4) 1122-1151
- 15 Bowers J, Ferguson JJ. Use of the activated clotting time in anticoagulation monitoring of intravascular procedures. Tex Heart Inst J 1993; 20 (4) 258-263
- 16 Conaglen PJ, Akowuah E, Theodore S, Atkinson V. Implications for cardiac surgery in patients with factor XII deficiency. Ann Thorac Surg 2010; 89 (2) 625-626
- 17 El Rouby S, Cohen M, Gonzales A , et al. The use of a HEMOCHRON JR. HEMONOX point of care test in monitoring the anticoagulant effects of enoxaparin during interventional coronary procedures. J Thromb Thrombolysis 2006; 21 (2) 137-145
- 18 Fressinaud E, Veyradier A, Truchaud F , et al. Screening for von Willebrand disease with a new analyzer using high shear stress: a study of 60 cases. Blood 1998; 91 (4) 1325-1331
- 19 Favaloro EJ. Clinical utility of the PFA-100. Semin Thromb Hemost 2008; 34 (8) 709-733
- 20 Hayward CP, Harrison P, Cattaneo M, Ortel TL, Rao AK ; Platelet Physiology Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Platelet function analyzer (PFA)-100 closure time in the evaluation of platelet disorders and platelet function. J Thromb Haemost 2006; 4 (2) 312-319
- 21 Streif W, Oliveri M, Weickardt S, Eberl W, Knoefler R ; Thromkid Study Group of GTH. Testing for inherited platelet defects in clinical laboratories in Germany, Austria and Switzerland. Results of a survey carried out by the Permanent Paediatric Group of the German Thrombosis and Haemostasis Research Society (GTH). Platelets 2010; 21 (6) 470-478
- 22 Seyfert UT, Haubelt H, Vogt A, Hellstern P. Variables influencing Multiplate(TM) whole blood impedance platelet aggregometry and turbidimetric platelet aggregation in healthy individuals. Platelets 2007; 18 (3) 199-206
- 23 Halimeh S, Angelis Gd, Sander A , et al. Multiplate whole blood impedance point of care aggregometry: preliminary reference values in healthy infants, children and adolescents. Klin Padiatr 2010; 222 (3) 158-163
- 24 Tantry US, Bonello L, Aradi D , et al; Working Group on On-Treatment Platelet Reactivity. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol 2013; 62 (24) 2261-2273
- 25 Breet NJ, van Werkum JW, Bouman HJ , et al. Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation. JAMA 2010; 303 (8) 754-762
- 26 Jakubowski JA, Payne CD, Li YG , et al. The use of the VerifyNow P2Y12 point-of-care device to monitor platelet function across a range of P2Y12 inhibition levels following prasugrel and clopidogrel administration. Thromb Haemost 2008; 99 (2) 409-415
- 27 Fries D. [Coagulation Monitoring using ROTEM(®): Pro]. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46 (5) 312-316
- 28 Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol 2014; 89 (2) 228-232
- 29 Mittermayr M, Velik-Salchner C, Stalzer B , et al. Detection of protamine and heparin after termination of cardiopulmonary bypass by thrombelastometry (ROTEM): results of a pilot study. Anesth Analg 2009; 108 (3) 743-750
- 30 Oswald E, Stalzer B, Heitz E , et al. Thromboelastometry (ROTEM) in children: age-related reference ranges and correlations with standard coagulation tests. Br J Anaesth 2010; 105 (6) 827-835
- 31 Haas T, Spielmann N, Mauch J , et al. Comparison of thromboelastometry (ROTEM®) with standard plasmatic coagulation testing in paediatric surgery. Br J Anaesth 2012; 108 (1) 36-41
- 32 NCGC National Clinical Guideline Centre, The Royal College of Physicians. June 2012. Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing. Available at: http://www.nice.org.uk/guidance/CG144. Accessed December 2014
- 33 Wells PS, Ginsberg JS, Anderson DR , et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med 1998; 129 (12) 997-1005
- 34 Keeling DM, Mackie IJ, Moody A, Watson HG ; Haemostasis and Thrombosis Task Force of the British Committee for Standards in Haematology. The diagnosis of deep vein thrombosis in symptomatic outpatients and the potential for clinical assessment and D-dimer assays to reduce the need for diagnostic imaging. Br J Haematol 2004; 124 (1) 15-25
- 35 Baglin T. The role of the laboratory in treatment with new oral anticoagulants. J Thromb Haemost 2013; 11 (Suppl. 01) 122-128
- 36 Schöchl H, Cadamuro J, Seidl S , et al. Hyperfibrinolysis is common in out-of-hospital cardiac arrest: results from a prospective observational thromboelastometry study. Resuscitation 2013; 84 (4) 454-459
- 37 Ives C, Inaba K, Branco BC , et al. Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma. J Am Coll Surg 2012; 215 (4) 496-502
- 38 Spencer Netto F, Tien H, Ng J , et al. Pulmonary emboli after blunt trauma: timing, clinical characteristics and natural history. Injury 2012; 43 (9) 1502-1506