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Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices.

Anesthesia and Analgesia

Viscosity, drug therapy, diagnosis, blood, Thrombosis, Thrombophilia, Thrombelastography, Reproducibility of Results, Quality of Health Care, Predictive Value of Tests, Postoperative Hemorrhage, standards, Point-of-Care Systems, therapeutic use, Platelet Aggregation Inhibitors, Perioperative Care, surgery, Liver, Humans, methods, instrumentation, Hemorheology, Equipment Design, Elasticity, Drug Monitoring, Digestive System Surgical Procedures, Coagulants, Cardiac Surgical Procedures, prevention & control, Blood Loss, Surgical, Blood Coagulation Tests, drug effects, Blood Coagulation, Anticoagulants

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      Abstract

      Perioperative monitoring of blood coagulation is critical to better understand causes of hemorrhage, to guide hemostatic therapies, and to predict the risk of bleeding during the consecutive anesthetic or surgical procedures. Point-of-care (POC) coagulation monitoring devices assessing the viscoelastic properties of whole blood, i.e., thrombelastography, rotation thrombelastometry, and Sonoclot analysis, may overcome several limitations of routine coagulation tests in the perioperative setting. The advantage of these techniques is that they have the potential to measure the clotting process, starting with fibrin formation and continue through to clot retraction and fibrinolysis at the bedside, with minimal delays. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Viscoelastic POC coagulation devices are increasingly being used in clinical practice, especially in the management of patients undergoing cardiac and liver surgery. Furthermore, they provide useful information in a large variety of clinical scenarios, e.g., massive hemorrhage, assessment of hypo- and hypercoagulable states, guiding pro- and anticoagulant therapies, and in diagnosing of a surgical bleeding. A surgical etiology of bleeding has to be considered when viscoelastic test results are normal. In summary, viscoelastic POC coagulation devices may help identify the cause of bleeding and guide pro- and anticoagulant therapies. To ensure optimal accuracy and performance, standardized procedures for blood sampling and handling, strict quality controls and trained personnel are required.

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      Journal
      10.1213/ane.0b013e318168b367
      18420846

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