title: [Basic algorithm for Point-of-Care based hemotherapy: perioperative treatment of coagulopathic patients].
abstract: During perioperative treatment of coagulopathic patients the so-called Point-of-Care (POC) analyses enable more rapidly available and more comprehensive hemostatic analyses compared to routinely performed conventional coagulation testing, such as activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen concentration and platelet count. In this review article a hemotherapy algorithm is presented which is based on viscoelastic and aggregometric POC measurements. The algorithm was designed double sided and consists of a general and a special part. The general part contains boxes and fields for sociodemographic data and gives general recommendations for coagulation management and therapy specifications for particular patient collectives and presents proposals for emergency reversal of anticoagulation therapy. The special part refers to basic physiological conditions for hemostasis and asks for measurement results of clot initiation, clot firmness, clot stability and platelet function analyses. Reference values were defined for each parameter and therapeutic options are presented. In cases of persistent coagulopathy despite algorithm-conform therapy, the algorithm could be run through once again. Finally, the algorithm presents therapeutic options for an ultima ratio therapy approach.
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt a. M., Deutschland. Christian.Weber@kgu.de
authors.forename: C F
authors.initials: CF
authors.lastname: Weber
authors.forename: K
authors.initials: K
authors.lastname: Zacharowski
authors.forename: K
authors.initials: K
authors.lastname: Brün
authors.forename: T
authors.initials: T
authors.lastname: Volk
authors.forename: E O
authors.initials: EO
authors.lastname: Martin
authors.forename: S
authors.initials: S
authors.lastname: Hofer
authors.forename: S
authors.initials: S
authors.lastname: Kreuer
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D001778:Blood Coagulation Disorders / Q000097:blood / Q000628:therapy*; D001784:Blood Gas Analysis; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D006487:Hemostasis; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D019934:International Normalized Ratio; D010314:Partial Thromboplastin Time; D019990:Perioperative Care / Q000379:methods*; D010979:Platelet Function Tests; D019095:Point-of-Care Systems; D012959:Socioeconomic Factors
chemical_list: D000925:Anticoagulants; D006490:Hemostatics