Christian Friedrich Weber1, Kai Zacharowski. 1. Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany. Christian.Weber@kgu.de
Abstract
BACKGROUND: Conventional laboratory tests of blood coagulation yield only partial diagnostic information. "Point of care" (POC) devices are increasingly being used at the bedside perioperatively for rapid, detailed testing of hemostatic function and for treatment monitoring in patients with coagulopathies. In this review, we discuss the benefits and limitations of POC coagulation testing-in particular, its effects on the rate of perioperative transfusion of allogeneic blood products, on the frequency of other types of hemostatic treatment, and on the clinical outcome. METHODS: This article is based on a selective review of pertinent literature retrieved by a search in PubMed. RESULTS: The clinical value of preoperative POC screening for coagulopathies has not yet been examined in a prospective, randomized clinical trial. On the other hand, studies in patients with coagulopathies undergoing (mainly cardiac) surgery have shown that algorithm-based hemostatic treatment based on viscoelastic POC coagulation testing reduces both perioperative blood loss and the rate of transfusion of allogeneic blood products. None of the studies published to date had adequate power to reveal any independent effect of POC coagulation testing on perioperative morbidity or mortality. CONCLUSION: Despite certain limitations that must be borne in mind, POC techniques are a valuable means of testing various aspects of hemostasis rapidly and in detail. Their implementation in hemostatic treatment algorithms may reduce both the rate of transfusion of allogeneic blood products and the total cost of treatment for blood loss and coagulopathies. The putative effect of POC testing on perioperative morbidity and mortality has not yet been demonstrated.
BACKGROUND: Conventional laboratory tests of blood coagulation yield only partial diagnostic information. "Point of care" (POC) devices are increasingly being used at the bedside perioperatively for rapid, detailed testing of hemostatic function and for treatment monitoring in patients with coagulopathies. In this review, we discuss the benefits and limitations of POC coagulation testing-in particular, its effects on the rate of perioperative transfusion of allogeneic blood products, on the frequency of other types of hemostatic treatment, and on the clinical outcome. METHODS: This article is based on a selective review of pertinent literature retrieved by a search in PubMed. RESULTS: The clinical value of preoperative POC screening for coagulopathies has not yet been examined in a prospective, randomized clinical trial. On the other hand, studies in patients with coagulopathies undergoing (mainly cardiac) surgery have shown that algorithm-based hemostatic treatment based on viscoelastic POC coagulation testing reduces both perioperative blood loss and the rate of transfusion of allogeneic blood products. None of the studies published to date had adequate power to reveal any independent effect of POC coagulation testing on perioperative morbidity or mortality. CONCLUSION: Despite certain limitations that must be borne in mind, POC techniques are a valuable means of testing various aspects of hemostasis rapidly and in detail. Their implementation in hemostatic treatment algorithms may reduce both the rate of transfusion of allogeneic blood products and the total cost of treatment for blood loss and coagulopathies. The putative effect of POC testing on perioperative morbidity and mortality has not yet been demonstrated.