title: Point-of-care monitoring of haemostasis.
abstract: Recent research in the management of haemorrhage has led to several changes in clinical practice. Evidence is accumulating that point-of-care testing results in fewer transfusions, improved patient outcomes, and reduced hospital costs. However, there is still insufficient high quality evidence to support transfusion guidelines and algorithms based on point-of-care tests alone, and more robust studies are needed. The implementation of point-of-care testing requires institutional support and senior clinical leadership to realise the benefits, with educational programmes, audit, and feedback regarding transfusion practice. A change in philosophy is required, from performing testing only when there is an obvious bleeding problem, towards the concept of routinely monitoring high-risk patients throughout the surgical procedure. This informs clinical practice, establishes normal ranges for that population, identifies patients at risk and allows early identification and treatment of evolving coagulopathy.
authors.affiliation: Department of Anaesthesia, Royal Free London NHS Trust, London, UK.
authors.forename: S V
authors.initials: SV
authors.lastname: Mallett
authors.forename: M
authors.initials: M
authors.lastname: Armstrong
mesh_terms: D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D006487:Hemostasis; D006801:Humans; D016031:Liver Transplantation; D019095:Point-of-Care Systems; D006473:Postpartum Hemorrhage / Q000628:therapy