Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

Görlinger, Klaus; Jámbor, Csilla; Hanke, Alexander; Dirkmann, Daniel; Adamzik, Michael; Hartmann, Matthias; Rahe‐Meyer, Niels

doi:10.1159/000109642

Cited by 88 publications

(74 citation statements)

References 107 publications

(125 reference statements)

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“…30 Whole blood impedance aggregometry in particular has been useful in detecting the effects of clopigogrel, desmopressin, and tranexamic acid. 31,32 Additionally, it can predict stent thrombosis and bleeding complications in patients undergoing cardiac procedures. Thus, a "therapeutic Multiple electrode Aggregometry window" balancing risks of bleeding and thrombosis can be defined, which would be ideal in patients with coronary stents.…”

Section: Point-of-care Testingmentioning

confidence: 99%

“…In pregnancy and long-standing diabetes, this has been shown to compensate for thrombocytopenia or platelet dysfunction, resulting in low responsiveness to antiplatelet therapy. 31,38,39 Accordingly, point-of-care tests may provide individualized therapy to reduce the risk of spinal bleeding and stent thrombosis. 13,24,31 Alternative Techniques for Pain Management Multimodal conservative pain management with intravenous and oral analgesia using opioids, nonsteroidal antiinflammatory agents, and/or acetaminophen is ideal if tolerated from a respiratory standpoint.…”

Section: Risk Of Stent Thrombosis After Coronary Artery Stent Implantmentioning

confidence: 99%

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Pain-associated Respiratory Failure in Chest Trauma

et al. 2013

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T he leading cause of death in young people is trauma. Chest trauma has high associated mortality, thus diagnosis and treatment need to be addressed early on presentation. 1 The incidence of rib fractures range from 10% to 26% in traumatic thoracic injury and the number of rib fractures independently predict patients' pulmonary morbidity and mortality.2 Numerous cardiopulmonary to neurologic causes such as tamponade, hemo-pneumothorax, and cervical spine injury can be implicated ( fig. 1). Severe respiratory distress can also result from breathing-dependent pain where parenteral opioids are often insufficient in addressing the pain and associated respiratory failure.3 epidural analgesia is associated with reduction in mortality for all patients with multiple rib fractures but is underused, in part due to the potential risks of epidural hematomas. 2,4 Variables that alter the risk of bleeding including age and sex, comorbidities such as diabetes and liver cirrhosis, severity of trauma and degree of resuscitation, and anticoagulation or antiplatelet therapy must also be considered.We describe a patient under clopidogrel therapy presenting to the intensive care unit (ICU) with severe respiratory distress that improved with epidural analgesia. We provide a discussion of the risks and benefits of neuraxial analgesia in patients presenting with rib-fracture pain-related respiratory failure. Case ReportA 79-yr-old man with a history of chronic obstructive pulmonary disease, bronchiectasis, coronary artery disease postplacement of bare-metal stent several years ago, hypertension, and diabetes was transferred to our hospital shortly after motor-vehicle collision. home medications were aspirin 325 mg, clopidogrel 75 mg per day (taken morning of accident), as well as inhaled tiotropium, inhaled fluticasone/ salmeterol, albuterol, isosorbide dinitrate, metformin, and simvastatin. On arrival, the patient was hemodynamically stable with pulse oximeter saturations of 94% on a nonrebreather mask with 60% inspired oxygen concentration. Computed tomography imaging revealed second to ninth anterior right rib fractures, fourth through ninth anterior left rib fractures, and posterior 10th and 11th left rib fractures, but without flail chest nor pneumothorax. A small left pleural effusion, left lung and lingular atelectasis, and minimal ground glass opacity in the right upper lobe, and a small right-lower lobe pulmonary contusion were shown ( fig. 2). The patient received 3 l lactated Ringer's solution before arriving in our ICU. his Injury Severity Score of 24 was primarily due to rib and lung injuries (16 points), then moderate head and surface injuries (4 points each).After admission to the surgical ICU, he developed increasing pain-related respiratory distress during the day. Tylenol was administered, and hydromorphone 0.2 mg intravenously produced somnolence, but minimal improvement of respiratory effort and pain. he had an electrocardiogram unremarkable for cardiac ischemia and negative cardiac isoenzymes and brain-natriuertic ...

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Section: Point-of-care Testingmentioning

confidence: 99%

Section: Risk Of Stent Thrombosis After Coronary Artery Stent Implantmentioning

confidence: 99%

Pain-associated Respiratory Failure in Chest Trauma

et al. 2013

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“…One limitation of this study is that thromboelastometry cannot assess von Willebrand factor and vascular wall disorders as well as platelet and endothelial cell dysfunction [23,25,46,47,48,49,50,51]. Of course, these factors have to be considered in case of microvascular bleeding, too.…”

Section: Discussionmentioning

confidence: 99%

“…Principles of thromboelastometry (ROTEM delta; Tem International GmbH, Munich, Germany) were described elsewhere [46,47,48,49,50,51]. Thromboelastometry has already widely been used to monitor coagulation changes and to guide coagulation therapy in trauma patients [35,36,37,43,44,45,52,53,54], during liver transplantation [4,16,23,25,38,41,42,43,44,45,47,55,56], and during cardiac surgery [24,25,39,43,44,45,57,58,59,60,61].…”

Section: Methodsmentioning

confidence: 99%

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

Fayed

Mourad

Yassen

et al. 2015

Transfus Med Hemother

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Background: The ability to predict transfusion requirements may improve perioperative bleeding management as an integral part of a patient blood management program. Therefore, the aim of our study was to evaluate preoperative thromboelastometry as a predictor of transfusion requirements for adult living donor liver transplant recipients. Methods: The correlation between preoperative thromboelastometry variables in 100 adult living donor liver transplant recipients and intraoperative blood transfusion requirements was examined by univariate and multivariate linear regression analysis. Thresholds of thromboelastometric parameters for prediction of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate transfusion requirements were determined with receiver operating characteristics analysis. The attending anesthetists were blinded to the preoperative thromboelastometric analysis. However, a thromboelastometry-guided transfusion algorithm with predefined trigger values was used intraoperatively. The transfusion triggers in this algorithm did not change during the study period. Results: Univariate analysis confirmed significant correlations between PRBCs, FFP, platelets or cryoprecipitate transfusion requirements and most thromboelastometric variables. Backward stepwise logistic regression indicated that EXTEM coagulation time (CT), maximum clot firmness (MCF) and INTEM CT, clot formation time (CFT) and MCF are independent predictors for PRBC transfusion. EXTEM CT, CFT and FIBTEM MCF are independent predictors for FFP transfusion. Only EXTEM and INTEM MCF were independent predictors of platelet transfusion. EXTEM CFT and MCF, INTEM CT, CFT and MCF as well as FIBTEM MCF are independent predictors for cryoprecipitate transfusion. Thromboelastometry-based regression equation accounted for 63% of PRBC, 83% of FFP, 61% of cryoprecipitate, and 44% of platelet transfusion requirements. Conclusion: Preoperative thromboelastometric analysis is helpful to predict transfusion requirements in adult living donor liver transplant recipients. This may allow for better preparation and less cross-matching prior to surgery. The findings of our study need to be re-validated in a second prospective patient population.

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“…Eine evidenzbasierte Interpretation der erhobenen Daten und die konsekutiv standardisierte Therapie wird mittels krankheitsspezifischer Behandlungsalgorithmen sichergestellt [11,12]. Einige Algorithmen berücksichtigen auch externe Einflussfaktoren wie Körpertemperatur und pH-Wert [13].…”

Section: Introductionunclassified

Ökonomie und Gerinnungsmanagement

Ehrlich¹

2013

Visc Med

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Hintergrund: Bei erworbenen oder chronisch bestehenden Störungen der Gerinnung ist in der perioperativen Phase eine gezielte Therapie von herausragender Bedeutung. Der kostenintensive Einsatz von Blut- und Gerinnungspräparaten und die Beeinflussung des Patientenoutcomes werden hinsichtlich des G-DRG(German Diagnosis Related Groups)-Systems und der Anwendung von Point-of-Care-Geräten bewertet. Methode: Anhand einer Literaturübersicht und eigener Daten wird der aktuelle Sachstand analysiert und diskutiert. Ergebnisse: Die perioperative Behandlung von Störungen der Gerinnung ist komplex. Neben der klassischen Labordiagnostik unterstützen und beschleunigen Point-of-Care-Geräte die Therapieentscheidungen. Die Anwendung eines Algorithmus-basierten Applikationsregimes von Blut- und Gerinnungspräparaten optimiert die Verbrauchsmengen und verbessert das Patientenoutcome. Demgegenüber können durch das G-DRG-System bedingte finanzielle Effekte aufgrund von kosten- und erlösseitigen Änderungen für das Krankenhaus negativ ausfallen. Fallpauschalen und Zusatzentgelte decken vor allem bei komplexen Behandlungsfällen wie der Lebertransplantation nicht die tatsächlichen Aufwendungen. Systemisch finanzielle Anreize zur Therapieentscheidung, die unabhängig von einer medizinischen Indikation sein können, sind vorherrschend. Schlussfolgerungen: Die Therapie von Gerinnungsstörungen stellt Ärzte, die Krankenhausverwaltungen und das G-DRG-System vor besondere Herausforderungen. Nicht selten besteht eine paradoxe Situation zwischen dem Streben nach einer bestmöglichen Patientenversorgung und einer adäquaten Leistungsvergütung des Krankenhauses. Finanzielle Anreize durch Pauschalen und Zusatzentgelte mit Mengenschwellen, die Therapieentscheidungen beeinflussen können, sind zukünftig zu eliminieren.

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Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

Cited by 88 publications

References 107 publications

Pain-associated Respiratory Failure in Chest Trauma

Pain-associated Respiratory Failure in Chest Trauma

Preoperative Thromboelastometry as a Predictor of Transfusion Requirements during Adult Living Donor Liver Transplantation

Ökonomie und Gerinnungsmanagement

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