Features  |   June 2015
Point-of-Care Coagulation Testing
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Coagulation and Transfusion / Hematologic System / Features
Features   |   June 2015
Point-of-Care Coagulation Testing
ASA Monitor 06 2015, Vol.79, 20-22.
ASA Monitor 06 2015, Vol.79, 20-22.
There are three different methods to analyze blood coagulation at the patient’s bedside (i.e., point of care, or POC). The first includes simple anticoagulation monitoring devices: activated clotting time (ACT), whole blood PT/INR and whole blood aPTT. These are being used for perioperative anticoagulant management and can be helpful in massively bleeding patients known to be on heparin therapy or vitamin K antagonists. Secondly, there are several POC coagulation tests available to assess primary hemostasis and platelet function (e.g., PFA-100/200 and modified platelet aggregometry). These bedside tests are most useful in the setting of antiplatelet therapy. Lastly, there are viscoelastic coagulation monitoring devices such as thromboelastography (TEG®; Haemonetics Corp., formerly Haemoscope Corp., Braintree, MA), rotational thromboelastometry (ROTEM®, Tem International GmbH, formerly Pentapharm GmbH, Munich, Germany) and Sonoclot® (Sonoclot Coagulation & Platelet Function Analyzer, Sienco Inc., Arvada, CO). These viscoelastic coagulation tests rapidly (five-30 minutes, depending on the parameter) assess the global clotting process from initial thrombin generation, to maximum clot formation, and ultimately clot lysis. In the management of bleeding patients, TEG® and ROTEM® are the most widely used viscoelastic devices and are based on a technique that was invented and introduced in the 1940s by Dr. Hartert in Heidelberg, Germany.1  In this article, we will primarily focus on the use of viscoelastic POC coagulation monitoring, TEG® and ROTEM® in the management of massively bleeding patients. Discussion of the other POC coagulation methods and other clinical indications are beyond of the scope of this review.
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