The surgical application of point-of-care haemostasis and platelet function testing.
BACKGROUND
Disordered coagulation complicates many diseases and their treatments, often predisposing to haemorrhage. Conversely, patients with cardiovascular disease who demonstrate antiplatelet resistance may be at increased thromboembolic risk. Prompt identification of these patients facilitates optimization of haemostatic dysfunction. Point-of-care (POC) tests are performed 'near patient' to provide a rapid assessment of haemostasis and platelet function.


METHODS
This article reviews situations in which POC tests may guide surgical practice. Their limitations and potential developments are discussed. The paper is based on a Medline and PubMed search for English language articles on POC haemostasis and platelet function testing in surgical practice.


RESULTS
POC tests identifying perioperative bleeding tendency are already widely used in cardiovascular and hepatic surgery. They are associated with reduced blood loss and transfusion requirements. POC tests to identify thrombotic predisposition are able to determine antiplatelet resistance, predicting thromboembolic risk. So far, however, these tests remain research tools.


CONCLUSIONS
POC haemostasis testing is a growing field in surgical practice. Such testing can be correlated with improved clinical outcome.
Leeds Vascular Institute, Leeds General Infirmary, Leeds, UK. kdickinson0@hotmail.com
K J
KJ
Dickinson
M
M
Troxler
S
S
Homer-Vanniasinkam
D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology; D002318:Cardiovascular Diseases / Q000097:blood* / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D006487:Hemostasis / Q000187:drug effects / Q000502:physiology; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D010979:Platelet Function Tests / Q000379:methods; D019095:Point-of-Care Systems; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013916:Thrombelastography / Q000379:methods; D013923:Thromboembolism / Q000517:prevention & control*
D010975:Platelet Aggregation Inhibitors