Point-of-Care-Testing – Point-of-Care-Testing und Hämotherapiealgorithmen

Thorsten Brenner; Stefan Hofer

doi:10.1055/s-0033-1347158

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2013; 48(5): 336-345
DOI: 10.1055/s-0033-1347158

Fachwissen

Anästhesiologie & Intensivmedizin Topthema: Point-of-Care-Testing

Point-of-Care-Testing – Point-of-Care-Testing und Hämotherapiealgorithmen

Point-of-care-testing and haemostaseological treatment algorithms

Thorsten Brenner

,

Stefan Hofer

Abstract

Zusammenfassung

Akute Blutungsereignisse bedürfen eines zeitnahen, zielgerichteten und maßvollen Gerinnungsmanagements. Voraussetzung hierfür ist eine schnell verfügbare sowie möglichst differenzierte Gerinnungsanalyse. Die Standardlaborparameter der konventionellen Gerinnungsanalyse (Quick, PTT, Fibrinogen, Thrombozytenzahl etc.) können hier nur bedingt weiterhelfen, da sie relevante diagnostische Schwächen aufweisen und die Messergebnisse erst mit einer nicht unerheblichen Zeitverzögerung bereitgestellt werden können. Bettseitig verfügbare Methoden des Point-of-Care-Testings (z.B. Thrombelastometrie, Vollblutaggregometrie) haben sich hier als überlegen erwiesen. Vor allem eine Implementierung dieser Methoden in ein algorithmenbasiertes Gerinnungsmanagement bietet die Möglichkeit, Einfluss auf das klinische Outcome zu nehmen und Gerinnungstherapie-assoziierte Kosten einzusparen.

Abstract

In patients suffering from acute haemorrhages, a prompt, targeted and restrained coagulation management is required. This should be based on a contemporary and sophisticated analysis of the coagulation system. Standard parameters (e.g. prothrombin time, international normalized ratio, plasma levels of fibrinogen, thrombocyte count etc.) seem not to be feasible, since they are hallmarked by a limited diagnostic value as well as a relevant turn around time. Bedside tools of haemostaseological point-of-care-testing (POCT, e.g. viscoelastic and aggregometric POCT) were shown to be superior in this setting. Especially the implementation of POCT-based treatment algorithms for patients suffering from acute haemorrhages was able to improve patient' outcome and resulted in reduced haemotherapy-associated costs.

Schlüsselwörter:

Point-of-Care-Gerinnungsmanagement - Thrombelastometrie - Vollblutaggregometrie - Algorithmen

Key words:

point-of-care coagulation management - thrombelastometry - whole blood aggregometry - algorithms

Full Text

References

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