title: Point-of-care versus central laboratory coagulation testing during haemorrhagic surgery. A multicenter study.
abstract: Delay in collecting coagulation test results from a central laboratory is one of the critical issues to efficiently control haemostasis during surgery. The aim of this multicenter study was to compare the performance of a point-of-care (POC) device (CoaguChek Pro DM) with the central laboratory-based coagulation testing during haemorrhagic surgery. For this purpose, 93 patients undergoing major surgical procedure were prospectively included in three centers. Blood was drawn from all patients before surgical incision and from most patients during surgical procedure after a blood loss of 25% or more was observed. When expressed in activity percentage, POC-based prothrombin time (PT) was in good agreement with central laboratory test result with coefficient of correlation in the range from 0.711 to 0.960 in the three centers. Comparison was less conclusive when PT was expressed in seconds or as the patient-to-control ratio and for activated partial thromboplastin time, with significantly shorter clotting times and lower ratios obtained on the POC device. On-site PT (in activity percentage) monitoring would have induced no significant change in fresh frozen plasma (FFP) transfusion in patients when compared to central laboratory monitoring. Test results were obtained in less than 5 minutes when performed using the POC device versus a median turnaround time of 88 minutes (range: 29-235 minutes) when blood collection tubes were sent to the central laboratory. These results suggest that, in providing a rapid answer, POC-based monitoring of PT (in percentage) using the CoaguChek device could be validly used in patients undergoing haemorrhagic surgical procedures.
authors.affiliation: CHU, Hôpital de Cimiez, Service d'Hématologie Biologique, 4 avenue de la Reine Victoria, BP 1179, F-06003 Nice Cedex 1, France. toulon.p@chu-nice.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Toulon
authors.forename: Yves
authors.initials: Y
authors.lastname: Ozier
authors.forename: Annick
authors.initials: A
authors.lastname: Ankri
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Fléron
authors.forename: Geneviève
authors.initials: G
authors.lastname: Leroux
authors.forename: Charles Marc
authors.initials: CM
authors.lastname: Samama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001800:Blood Specimen Collection; D019411:Clinical Laboratory Techniques; D005260:Female; D005602:France; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time / Q000295:instrumentation*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011517:Prothrombin Time / Q000295:instrumentation*; D015203:Reproducibility of Results; D013997:Time Factors; D055815:Young Adult