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

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.

Kernaussagen

• Kennzeichen einer modernen Hämotherapie sind der restriktive Einsatz allogener Blutprodukte sowie eine individuelle bzw. patientenadaptierte Gerinnungstherapie.

• Bettseitig verfügbare POC-Verfahren ermöglichen eine zeitnah verfügbare und äußerst differenzierte Gerinnungsanalyse. Sie sind im Fall einer akuten Blutung den Standardverfahren der Gerinnungsdiagnostik hinsichtlich diagnostischer Wertigkeit und „turn-around time“ überlegen.

• Mittels viskoelastischer POC-Verfahren kann die Zeit bis zur Gerinnselbildung (Gerinnungsaktivierung; vgl. Quick, INR, PTT) bestimmt werden. Darüber hinaus wird eine funktionelle Analyse der zur Gerinnselstärke und -stabilität beitragenden Einzelkomponenten (Fibrinogen, Thrombozyten, Fibrinolyse) ermöglicht.

• Eine diagnostische Lücke der viskoelastischen POC-Verfahren besteht in der fehlenden Detektion von Thrombozytenfunktionsstörungen. Diese Lücke kann durch aggregometrische POC-Verfahren geschlossen werden.

• Die Implementierung von POC-Methoden in das Gerinnungsmanagement sollte in Form von Algorithmen erfolgen, die Patientenkollektiv-spezifische Ursachen für die jeweilige Blutungskomplikation berücksichtigen. Hierdurch lassen sich das klinische Outcome verbessern und Gerinnungstherapie-assoziierte Kosten einsparen.

Schlüsselwörter:

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

Key words:

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

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