Point of Care Coagulation Tests in Critically Ill Patients

ABSTRACT

Point of care assays for various analytes have been established in critical care, including blood gas analysis, glucose, electrolytes, and markers for cardiac ischemia. Coagulation assays can also be adapted to the critical care environment by using whole blood as sample material and instruments optimized for point of care analysis. Available assays include the conventional coagulation assays, such as prothrombin time and activated partial thromboplastin time, fibrinogen, assays for monitoring of anticoagulant drugs, global coagulation assays based on thrombelastography and viscosimetry, platelet function assays, and D-dimer assays. The main problem in point of care coagulation diagnostics is quality control. Point of care coagulation assays help in rapidly establishing a diagnosis, clarifying causes of bleeding, and monitoring therapy. Thrombelastography and similar assays extend the scope of coagulation diagnostics by visualizing the process of clot formation and extending the observation period to provide an estimate of clot stability versus mechanical and proteolytic attack.

Blood coagulation tests - critical care medicine - thrombelastography - D-dimer - platelet function

REFERENCES

• 1 Armand R, Hess J R. Treating coagulopathy in trauma patients.  Transfus Med Rev. 2003;  17 223-231
• 2 Hardy J F, de Moerloose P, Samama C M. The coagulopathy of massive transfusion.  Vox Sang. 2005;  89 123-127
• 3 Yuan S, Ferrell C, Chandler W L. Comparing the prothrombin time INR versus the APTT to evaluate the coagulopathy of acute trauma.  Thromb Res. 2007;  120 29-37
• 4 Yin E T, Wessler S, Butler J V. Plasma heparin: a unique, practical, submicrogram-sensitive assay.  J Lab Clin Med. 1973;  81 298-310
• 5 Bara L, Combe-Tamzali S, Conard J, Horellou M H, Samama M. Laboratory monitoring of a low molecular weight heparin (enoxaparin) with a new clotting test (Heptest).  Haemostasis. 1987;  17 127-133
• 6 Hellstern P, Bach J, Simon M, Saggau W. Heparin monitoring during cardiopulmonary bypass surgery using the one-step point-of-care whole blood anti-factor-Xa clotting assay heptest-POC-Hi.  J Extra Corpor Technol. 2007;  39 81-86
• 7 Homoncik M, Pernerstorfer T, Reiter R, Knechtelsdorfer M, Quehenberger P, Jilma B. Point of care measurement of lepirudin and heparin anticoagulation during systemic inflammation.  Thromb Res. 2002;  108 91-95
• 8 Samama C M, 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
• 9 Tanaka K A, Taketomi T, Szlam F, Calatzis A, Levy J H. Improved clot formation by combined administration of activated factor VII (NovoSeven) and fibrinogen (Haemocomplettan P).  Anesth Analg. 2008;  106 732-738
• 10 Schmid S, Friesenecker B, Lorenz I et al.. Administration of recombinant activated factor VII (NovoSeven) in three cases of uncontrolled bleeding caused by disseminated intravascular coagulopathy.  Clin Appl Thromb Hemost. 2007;  13 313-317
• 11 Martinowitz U, Michaelson M. Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rFVIIa Task Force.  J Thromb Haemost. 2005;  3 640-648
• 12 Simko R J, Tsung F F, Stanek E J. Activated clotting time versus activated partial thromboplastin time for therapeutic monitoring of heparin.  Ann Pharmacother. 1995;  29 1015-1021 , quiz 1061
• 13 Bommer J, Schwab M. Bedside testing with the new CoaguChek Pro activated clotting time assay in dialysis.  Artif Organs. 2002;  26 387-390
• 14 Gerhardt M A, Greenberg C S, Slaughter T F, Stafford Smith M. Factor XII deficiency and cardiopulmonary bypass: use of a novel modification of the activated clotting time to monitor anticoagulation.  Anesthesiology. 1997;  87 990-992
• 15 Hartert H. Thrombelastography, a method for physical analysis of blood coagulation.  Z Gesamte Exp Med. 1951;  117 189-203
• 16 Hartert H. Coagulopathies and thrombelastography.  Thromb Diath Haemorrh. 1962;  6(Suppl 2) 31-35
• 17 Spiel A O, Mayr F B, Firbas C, Quehenberger P, Jilma B. Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans.  J Thromb Haemost. 2006;  4 411-416
• 18 Nielsen V G. A comparison of the thrombelastograph and the ROTEM.  Blood Coagul Fibrinolysis. 2007;  18 247-252
• 19 Tynngard N, Lindahl T, Ramstrom S, Berlin G. Effects of different blood components on clot retraction analysed by measuring elasticity with a free oscillating rheometer.  Platelets. 2006;  17 545-554
• 20 Rugeri L, Levrat A, David J S et al.. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography.  J Thromb Haemost. 2007;  5 289-295
• 21 Levrat A, Gros A, Rugeri L et al.. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients.  Br J Anaesth. 2008;  100 792-797
• 22 Fries D, Krismer A, Klingler A et al.. Effect of fibrinogen on reversal of dilutional coagulopathy: a porcine model.  Br J Anaesth. 2005;  95 172-177
• 23 Fenger-Eriksen C, Anker-Moller E, Heslop J, Ingerslev J, Sorensen B. Thrombelastographic whole blood clot formation after ex vivo addition of plasma substitutes: improvements of the induced coagulopathy with fibrinogen concentrate.  Br J Anaesth. 2005;  94 324-329
• 24 Plotkin A J, Wade C E, Jenkins D H et al.. A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries.  J Trauma. 2008;  64 S64-S68
• 25 Nielsen V G, Gurley Jr W Q, Burch T M. The impact of factor XIII on coagulation kinetics and clot strength determined by thrombelastography.  Anesth Analg. 2004;  99 120-123
• 26 Wettstein P, Haeberli A, Stutz M et al.. Decreased factor XIII availability for thrombin and early loss of clot firmness in patients with unexplained intraoperative bleeding.  Anesth Analg. 2004;  99 1564-1569
• 27 Burghardt W R, Goldstick T K, Leneschmidt J, Kempka K. Nonlinear viscoelasticity and the thrombelastograph: 1. Studies on bovine plasma clots.  Biorheology. 1995;  32 621-630
• 28 Mengistu A M, Wolf M W, Boldt J, Rohm K D, Lang J, Piper S N. Evaluation of a new platelet function analyzer in cardiac surgery: a comparison of modified thromboelastography and whole-blood aggregometry.  J Cardiothorac Vasc Anesth. 2008;  22 40-46
• 29 Scharbert G, Gebhardt K, Sow Z, Duris M, Deusch E, Kozek-Langenecker S. Point-of-care platelet function tests: detection of platelet inhibition induced by nonopioid analgesic drugs.  Blood Coagul Fibrinolysis. 2007;  18 775-780
• 30 Favaloro E J, Facey D, Henniker A. Use of a novel platelet function analyzer (PFA-100) with high sensitivity to disturbances in von Willebrand factor to screen for von Willebrand's disease and other disorders.  Am J Hematol. 1999;  62 165-174
• 31 Harrison P, Robinson M S, Mackie I J et al.. Performance of the platelet function analyser PFA-100 in testing abnormalities of primary haemostasis.  Blood Coagul Fibrinolysis. 1999;  10 25-31
• 32 Buyukasik Y, Karakus S, Goker H et al.. Rational use of the PFA-100 device for screening of platelet function disorders and von Willebrand disease.  Blood Coagul Fibrinolysis. 2002;  13 349-353
• 33 Kenet G, Lubetsky A, Shenkman B et al.. Cone and platelet analyser (CPA): a new test for the prediction of bleeding among thrombocytopenic patients.  Br J Haematol. 1998;  101 255-259
• 34 Shenkman B, Savion N, Dardik R, Tamarin I, Varon D. Testing of platelet deposition on polystyrene surface under flow conditions by the cone and plate(let) analyzer: role of platelet activation, fibrinogen and von Willebrand factor.  Thromb Res. 2000;  99 353-361
• 35 Varon D, Lashevski I, Brenner B et al.. Cone and plate(let) analyzer: monitoring glycoprotein IIb/IIIa antagonists and von Willebrand disease replacement therapy by testing platelet deposition under flow conditions.  Am Heart J. 1998;  135 S187-S193
• 36 Gurbel P A, Bliden K P, DiChiara J et al.. Evaluation of dose-related effects of aspirin on platelet function: results from the Aspirin-Induced Platelet Effect (ASPECT) study.  Circulation. 2007;  115 3156-3164
• 37 Dempfle C E, Korte W, Schwab M, Zerback R, Huisman M V. Sensitivity and specificity of a quantitative point of care D-dimer assay using heparinized whole blood, in patients with clinically suspected deep vein thrombosis.  Thromb Haemost. 2006;  96 79-83
• 38 Wada H, Wakita Y, Nakase T et al.. Outcome of disseminated intravascular coagulation in relation to the score when treatment was begun. Mie DIC Study Group.  Thromb Haemost. 1995;  74 848-852
• 39 Taylor Jr F B, Toh C H, Hoots W K, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation.  Thromb Haemost. 2001;  86 1327-1330
• 40 Lee J H, Song J W, Song K S. Diagnosis of overt disseminated intravascular coagulation: a comparative study using criteria from the International Society versus the Korean Society on Thrombosis and Hemostasis.  Yonsei Med J. 2007;  48 595-600
• 41 Gando S, Iba T, Eguchi Y et al.. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria.  Crit Care Med. 2006;  34 625-631
• 42 Dempfle C E, Zips S, Ergul H, Heene D L. The Fibrin Assay Comparison Trial (FACT): evaluation of 23 quantitative D-dimer assays as basis for the development of D-dimer calibrators. FACT study group.  Thromb Haemost. 2001;  85 671-678
• 43 Dempfle C E, Wurst M, Smolinski M et al.. Use of soluble fibrin antigen instead of D-dimer as fibrin-related marker may enhance the prognostic power of the ISTH overt DIC score.  Thromb Haemost. 2004;  91 812-818
• 44 Bakhtiari K, Meijers J C, de Jonge E, Levi M. Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation.  Crit Care Med. 2004;  32 2416-2421
• 45 Angstwurm M W, Dempfle C E, Spannagl M. New disseminated intravascular coagulation score: a useful tool to predict mortality in comparison with Acute Physiology and Chronic Health Evaluation II and Logistic Organ Dysfunction scores.  Crit Care Med. 2006;  34 314-320 , quiz 328
• 46 Voves C, Wuillemin W A, Zeerleder S. International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients.  Blood Coagul Fibrinolysis. 2006;  17 445-451
• 47 Kienast J, Juers M, Wiedermann C J et al.. Treatment effects of high-dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation.  J Thromb Haemost. 2006;  4 90-97
• 48 Akutsu K, Sato N, Yamamoto T et al.. A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection.  Circ J. 2005;  69 397-403
• 49 Eggebrecht H, Naber C K, Bruch C et al.. Value of plasma fibrin D-dimers for detection of acute aortic dissection.  J Am Coll Cardiol. 2004;  44 804-809
• 50 Marill K A. Serum D-dimer is a sensitive test for the detection of acute aortic dissection: a pooled meta-analysis.  J Emerg Med. 2008;  34 367-376
• 51 Salvagno G L, Targher G, Franchini M, Lippi G. Plasma D-dimer in the diagnosis of acute aortic dissection.  Eur Heart J. 2008;  29 1207 , author reply 1207–1208
• 52 Sodeck G, Domanovits H, Schillinger M et al.. D-dimer in ruling out acute aortic dissection: a systematic review and prospective cohort study.  Eur Heart J. 2007;  28 3067-3075
• 53 Weber T, Hogler S, Auer J et al.. D-dimer in acute aortic dissection.  Chest. 2003;  123 1375-1378
• 54 Weber T, Auer J, Eber B, Nienaber C A, Eagle K A. Value of d-dimer testing in acute aortic dissection.  Circulation. 2004;  109 E24
• 55 Perez A, Abbet P, Drescher M J. D-dimers in the emergency department evaluation of aortic dissection.  Acad Emerg Med. 2004;  11 397-400
• 56 Chilver-Stainer L, Lammle B, Alberio L. Titre of anti-heparin/PF4-antibodies and extent of in vivo activation of the coagulation and fibrinolytic systems.  Thromb Haemost. 2004;  91 276-282
• 57 Kumar R, Ansell J E, Canoso R T, Deykin D. Clinical trial of a new bleeding-time device.  Am J Clin Pathol. 1978;  70 642-645
• 58 Boberg K M, Brosstad F, Egeland T, Egge T, Schrumpf E. Is a prolonged bleeding time associated with an increased risk of hemorrhage after liver biopsy?.  Thromb Haemost. 1999;  81 378-381
• 59 Peterson P, Hayes T E, Arkin C F et al.. The preoperative bleeding time test lacks clinical benefit: College of American Pathologists' and American Society of Clinical Pathologists' position article.  Arch Surg. 1998;  133 134-139
• 60 Romlin B, Petruson K, Nilsson K. Moderate superficial hypothermia prolongs bleeding time in humans.  Acta Anaesthesiol Scand. 2007;  51 198-201