Download PDF
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
1   Université de Nice-Sophia Antipolis, Faculté de Médecine, Service d’Hématologie Biologique, Nice, France
2   Service d’Hématologie Biologique, Université Paris Descartes, Hôpital Cochin, Paris, France
,
Yves Ozier
3   Département d’Anesthésie-Réanimation, Université Paris Descartes, Hôpital Cochin, Paris, France
,
Annick Ankri
4   Service d’Hématologie Biologique, Hôpital La-Pitié-Salpétrière, Paris, France
,
Marie-Hélène Fléron
5   Département d’AnesthésieRéanimation, Hôpital La-Pitié-Salpétrière, Paris, France
,
Geneviève Leroux
6   Laboratoire d’Hématologie, Hôpital Avicenne, Bobigny, France
,
Charles Marc Samama
7   Département d’Anesthésie-Réanimation, Hôpital Avicenne, Bobigny, France
› Author Affiliations
Further Information

Publication History

Received: 17 June 2008

Accepted after major revision: 17 January 2008

Publication Date:
25 November 2017 (online)

    Permissions and Reprints

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
 

  • References

  • 1 O’Shaughnessy DF, Atterbury C, Bolton Maggs P. et al. British Committee for Standards in Haematology, Blood Transfusion Task Force.. Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 2004; 126: 11-28.
    CrossrefPubMedGoogle Scholar
  • 2 American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies.. Practice guidelines for perioperative blood transfusion and adjuvant therapies. An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006; 105: 198-208.
    CrossrefPubMedGoogle Scholar
  • 3 AFSSAPS.. Transfusion de plasma frais congelé: produits, indications. 2002 http://agmed.sante.gouv.fr/pdf/5/rbp/tpfarg.pdf
    PubMedGoogle Scholar
  • 4 Kozek-Langenecker S. Management of massive operative blood loss. Minerva Anestesiol 2007; 73: 401-415.
    PubMedGoogle Scholar
  • 5 Ketchum L, Hess JR, Hiippala S. Indications for early fresh frozen plasma, cryoprecipitate, and platelet transfusion in trauma. J Trauma 2006; 60 Suppl S51-S58.
    CrossrefPubMedGoogle Scholar
  • 6 Samama CM, Ozier Y. Near-patient testing of haemostasis in the operating theatre: an approach to appropriate use of blood in surgery. Vox Sang 2003; 84: 251-255.
    CrossrefPubMedGoogle Scholar
  • 7 Sie P, Steib A. Central laboratory and point of care assessment of perioperative hemostasis. Can J Anesth 2006; 53 (06) S12-S20.
    CrossrefPubMedGoogle Scholar
  • 8 Jahn UR, Van Aken H. Editorial I: Near-patient testing-point-of-care or point of costs and convenience?. Br J Anaesth 2003; 90: 425-427.
    CrossrefPubMedGoogle Scholar
  • 9 Stief TW, Fareed J. Point of care: diagnostics in hemostasis – the wrong direction?. J Clin Appl Thromb Hemost 2003; 9: 191-195.
    PubMedGoogle Scholar
  • 10 Vacas M, Lafuente PJ, Cuesta S. et al. Comparative study of a portable monitor for prothrombin time determination, Coaguchek, with three systems for control of oral anticoagulant treatment. Haemostasis 1998; 28: 321-328.
    PubMedGoogle Scholar
  • 11 van den Besselar AMHP. A comparison of INRs determined with a whole blood prothrombin time device and two international reference preparations for thromboplastin. Thromb Haemost 2000; 84: 410-412.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Attermann J, Andersen NT, Korsgaard H. et al. Precision of INR measured with a patient operated whole blood coagulometer. Thromb Res 2003; 110: 65-68.
    CrossrefPubMedGoogle Scholar
  • 13 Fitzmaurice DA, Murray ET, Gee KM. et al. A randomised controlled trial of patient self management of oral anticoagulation treatment compared with primary care management. J Clin Pathol 2002; 55: 845-849.
    CrossrefPubMedGoogle Scholar
  • 14 Hasenkam JM, Knudsen L, Kimose HH. et al. Practicability of patient self-testing of oral anticoagulant therapy by the international normalized ratio (INR) using a portable whole blood monitor. A pilot investigation. Thromb Res 1997; 85: 77-82.
    CrossrefPubMedGoogle Scholar
  • 15 Bauman ME, Black KL, Massicotte MP. et al. Accuracy of the CoaguChek XS for point-of-care international normalized ratio measurement in children requiring warfarin. Thromb Haemost 2008; 99: 1097-1103.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Samama CM, Quezada R, Riou B. et al. Intraoperative measurement of activated partial thromboplastin time and prothrombin time with a new compact monitor. Acta Anaesthesiol Scand 1994; 38: 232-237.
    CrossrefPubMedGoogle Scholar
  • 17 Boldt J, Walz G, Triem J, Suttner S, Kumle B. Point-of-care (POC) measurement of coagulation after cardiac surgery. Intensive Care Med 1998; 24: 1187-1193.
    CrossrefPubMedGoogle Scholar
  • 18 Jack J, Chavez JJ, Weatherall JS. et al. Evaluation of a point-of-care coagulation analyzer on patients undergoing cardiopulmonary bypass surgery. J Clin Anesth 2004; 16: 7-10.
    CrossrefPubMedGoogle Scholar
  • 19 Zalunardo MP, Zollinger A, Seifert B. et al. Peri-operative reliability of an on-site prothrombin time assay under different haemostatic conditions. Br J Anaesth 1998; 81: 533-536.
    CrossrefPubMedGoogle Scholar
  • 20 ISO 6710. 1995 Single-use containers for venous blood specimen collection. Version 1996–02. ISO Editions 1996.
    PubMedGoogle Scholar
  • 21 Walker ID. Blood collection and sample preparation: pre-analytical variation. In: Jespersen J, Bertina RM, Haverkate F. (editors). Laboratory techniques in thrombosis – A manual. 2nd revised edition of ECAT assay procedures. Dordrecht, The Netherlands: Kluwer Academic Publishers; 1999: 21-28.
    Google Scholar
  • 22 Polack B, Schved J-F, Boneu B. on behalf of the ‘Groupe d’Etude sur l‘Hémostase et la Thrombose’ [GEHT]. Preanalytical recommendations of the ‘Groupe d’Etude sur l‘Hémostase et la Thrombose’ (GEHT) for venous blood testing in hemostasis laboratories. Haemostasis 2001; 31: 61-68.
    PubMedGoogle Scholar
  • 23 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; I: 307-310.
    PubMedGoogle Scholar
  • 24 Ferring M, Reber G, de Moerloose P, Merlani P, Diby M, Ricou B. Point of care and central laboratory determinations of the aPTT are not interchangeable in surgical intensive care patients. Can J Anaesth 2001; 48: 1155-1160.
    CrossrefPubMedGoogle Scholar
  • 25 Johi RR, Cross MH, Hansbro SD. Near-patient testing for coagulopathy after cardiac surgery. Br J Anaesth 2003; 90: 499-501.
    CrossrefPubMedGoogle Scholar
  • 26 Murray D, Pennell B, Olson J. Variability of prothrombin time and activated partial thromboplastin time in the diagnosis of increased surgical bleeding. Transfusion 1999; 39: 56-62.
    CrossrefPubMedGoogle Scholar
  • 27 Despotis GJ, Alsoufiev A, Goodnough LT. et al. Aprotinin prolongs whole blood activated partial thromboplastin time but not whole blood prothrombin time in patients undergoing cardiac surgery. Anesth Analg 1995; 81: 919-924.
    PubMedGoogle Scholar
  • 28 Guidelines for point-of-care testing: haematology. Br J Haematol 2008; 142: 904-915.
    CrossrefPubMedGoogle Scholar