title: Rapid bedside coagulometry prior to urgent neurosurgical procedures in anticoagulated patients.
abstract: BACKGROUND
  With the increased use of oral anticoagulation with vitamin K antagonists, emergency physicians encounter a growing number of patients requiring a rapid reversal of anticoagulant effects in order to perform urgent surgical procedures. Initiation of these procedures can be delayed because the coagulation status has to be assessed through examination of blood samples in central laboratories (CL). This delay may lead to negative effects, especially in potentially life-threatening conditions such as intracranial haemorrhage. Point-of-care (POC) devices for assessment of international normalized ratio (POC INR) have improved the management of anticoagulation therapy in the outpatient setting. The use of these devices may also have beneficial effects in the treatment of anticoagulated patients requiring urgent neurosurgical procedures. The primary aim of this study was to analyse the potential of POC-guided assessment of INR to reduce time to potentially life-saving neurosurgery in this setting. Feasibility and accuracy as well as the gain of time through the use of this device were analysed.
  
  
  METHODS
  The POC coagulometer CoaguChek XS(®) was used in 17 patients with a history of anticoagulant use and a condition requiring urgent anticoagulant reversal prior to neurosurgical procedures (burr-hole trepanation: n = 8, craniotomy: n = 7, laminectomy: n = 2).
  
  
  RESULTS
  No technical difficulties occurred and rapid assessment of INR was achieved in all cases within 2 min. POC INR values correlated well with CL INR assessment with a mean INR deviation of 0.036 ± 0.12. The mean gain of time through the use of the POC INR device compared with CL assessment of INR was 47 ± 6 min (range: 37-61 min).
  
  
  CONCLUSIONS
  Our initial experiences with a POC INR device in anticoagulated patients undergoing urgent neurosurgical procedures demonstrate that its use may contribute to an improved management of these patients.
authors: Department of Neurosurgery, Heidelberg University Hospital , Heidelberg , Germany.
authors: Christopher
authors: C
authors: Beynon
authors: Martin
authors: M
authors: Jakobs
authors: Timolaos
authors: T
authors: Rizos
authors: Andreas W
authors: AW
authors: Unterberg
authors: Oliver W
authors: OW
authors: Sakowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000097:blood / Q000494:pharmacology; D001777:Blood Coagulation / Q000502:physiology*; D004864:Equipment and Supplies / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000592:standards*; D013997:Time Factors
chemical_list: D000925:Anticoagulants