On-the-spot test aids postsurgical coagulopathy management

Sep 5 2012

By Eleanor McDermid, Senior medwireNews Reporter

Point-of-care (POC) thromboelastometric and aggregometric testing helps to reduce exposure to allogenic blood products in patients with coagulopathy after cardiac surgery, a randomized trial shows.

During 24 hours after detection of coagulopathy, patients assessed with the POC tests received a median of 3 units of packed erythrocytes, whereas those assigned to conventional testing received 5 units.

This difference was significant, and was detected after an interim analysis when the study had recruited 100 patients - just half of the planned number - causing it to be stopped early. Patients in the POC testing group also received less fresh frozen plasma than those in the conventional testing group, at a median of 20 versus 40 units.

Furthermore, the cost of POC testing per patient was about half that of conventional testing, Klaus Görlinger (University Hospital Essen, Germany) and team note in Anesthesiology.

The reduction in erythrocyte transfusion with POC testing was associated with improved clinical outcomes, seen from 4 hours after intensive care unit (ICU) admission. Adverse events (acute renal failure, sepsis, thrombotic complications, and allergic reactions) occurred significantly less often in the POC group than in the conventional group (8 vs 38% at 24 hours).

Over the following 6 months, significantly fewer patients in the POC testing group died, at 4% compared with 20% of the conventional-testing group. Although this difference confirmed the researchers' observations in a previous retrospective study, they say that "the dimension of the observed reduction in mortality exceeded our expectations."

Görlinger et al stress that mortality was a secondary outcome that the study was not powered for, but say: "These data suggest that POC-guided hemostatic therapy is, at least in part, associated with improved clinical outcome."

The researchers believe that the benefits of the POC test arise because the test focuses on functionality, whereas conventional coagulation tests are quantitative. "Considering the multifactorial pathophysiology of perioperative hemorrhage during cardiac surgery, standard laboratory coagulation tests are of limited diagnostic value."

They say: "This may allow for more specific goal-directed interventions to reduce both transfusion requirements and thromboembolic complications."

Also, conventional test results are available in 30-45 minutes, whereas the POC tests are ready in 15-20 minutes, which speeds therapeutic decisions and intervention. The combination of speed and more specific interventions therefore reduces blood loss, the team suggests. After 24 hours in the ICU, patients in the POC group had lost a median of 600 mL blood (via test tube), compared with 900 mL in the conventional testing group.

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