Point-of-Care Diagnostics in Coagulation Management

Sahli, Sebastian D.; Rössler, Julian; Tscholl, David W.; Studt, Jan‐Dirk; Spahn, Donat R.; Kaserer, Alexander

doi:10.3390/s20154254

Cited by 32 publications

(30 citation statements)

References 103 publications

(139 reference statements)

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“…Several assays are available for diverse drugs with different mechanisms of platelet inhibition, and the generation of results takes from six to ten minutes. The ROTEM ® platelet module (Instrumentation Laboratory, Bedford, MA, USA) and TEG ® (Haemonetics Corporation, Boston, MA, USA) can be used for detection of cyclooxygenase (COX) inhibitors, adenosine diphosphate (ADP) receptor inhibitors and GpIIb-IIIa antagonists [ 92 ]. The Platelet Function Analyzer-100 (PFA-100 ® , Siemens, Munich, Germany) is completely automatized and user friendly, based on platelets adhesion under high shear force [ 93 ].…”

Section: Point-of-care Diagnostics In Haematology and Biochemistrymentioning

confidence: 99%

“…The VerifyNow ® platelet reactivity assay (ITC, Edison NJ, USA) is a further fully automated POC test using whole blood samples for monitoring of antiplatelet therapy, providing results also within a few minutes [ 92 ], though here the haematocrit might also falsify the test results [ 95 ]. Moreover, transport of samples using pneumatic tube transport may affect platelet function testing [ 96 ].…”

Section: Point-of-care Diagnostics In Haematology and Biochemistrymentioning

confidence: 99%

“…The platelet function assessment with POC tests is still unsatisfactory [ 92 ]. Further improvement of technology could lead to more accurate, reproducible, affordable and reliable results.…”

Section: Point-of-care Diagnostics In Haematology and Biochemistrymentioning

confidence: 99%

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Diagnostic Modalities in Critical Care: Point-of-Care Approach

et al. 2021

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The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.

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Section: Point-of-care Diagnostics In Haematology and Biochemistrymentioning

confidence: 99%

Section: Point-of-care Diagnostics In Haematology and Biochemistrymentioning

confidence: 99%

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Diagnostic Modalities in Critical Care: Point-of-Care Approach

et al. 2021

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“…For example, the European guideline on the management of major hemorrhage after trauma favors viscoelasticguided transfusion algorithms [7], while many large trauma centers in other parts of the world prefer predefined fixed ratio transfusion protocols [6,8]. The multifactorial causes of bleeding [9,10] and various methods of detecting coagulation disorders [11,12] further complicate the understanding of this topic.…”

Section: Introductionmentioning

confidence: 99%

Physicians’ perceptions regarding acute bleeding management: an international mixed qualitative quantitative study

et al. 2021

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Background Acute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients’ outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients. Methods This investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants’ answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test. Results We included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: “Complexity of the topic” (52.4% agreed to find the topic complex), “Cognitive aids” (92.9% agreed to find them helpful), “Time management” (64.3% agreed to feeling time pressure), “Human factors” (95.2% agreed that human factors are essential), “Resources” (95.2% agreed that resources are essential), “Experience” and “Low frequency of cases” (57.1% agreed to lack practice), “Diagnostic methods” (31.0% agreed that the interpretation of test results is difficult), “Anticoagulation” (85.7% agreed to it being difficult), “Treatment” (81.0% agreed to knowing the first therapeutic steps), and “Nothing”. Conclusions Anesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

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“…For example, the European guideline on the management of major hemorrhage after trauma favors viscoelastic-guided transfusion algorithms [7], while many large trauma centers in other parts of the world prefer prede ned xed ratio transfusion protocols [6,8]. The multifactorial causes of bleeding [9,10] and various methods of detecting coagulation disorders [11,12] further complicate the understanding of this topic.…”

Section: Introductionmentioning

confidence: 99%

Step Back and Reassess - What Physicians See as Challenges in Treating Patients with Acute Bleeding: International, Mixed Qualitative and Quantitative Study.

Roche¹,

Wetli²,

Braun³

et al. 2020

Preprint

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Background: Acute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients’ outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients. Methods: This investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants’ answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test. Results: We included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: “Complexity of the topic” (52.4% agreed to find the topic complex), “Cognitive aids” (92.9% agreed to find them helpful), “Time management” (64.3% agreed to feeling time pressure), “Human factors” (95.2% agreed that human factors are essential), “Resources” (95.2% agreed that resources are essential), “Experience” and “Low frequency of cases” (57.1% agreed to lack practice), “Diagnostic methods” (31.0% agreed that the interpretation of test results is difficult), “Anticoagulation” (85.7% agreed to it being difficult), “Treatment” (81.0% agreed to knowing the first therapeutic steps), and “Nothing”.Conclusions: Anesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

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Point-of-Care Diagnostics in Coagulation Management

Cited by 32 publications

References 103 publications

Diagnostic Modalities in Critical Care: Point-of-Care Approach

Diagnostic Modalities in Critical Care: Point-of-Care Approach

Physicians’ perceptions regarding acute bleeding management: an international mixed qualitative quantitative study

Step Back and Reassess - What Physicians See as Challenges in Treating Patients with Acute Bleeding: International, Mixed Qualitative and Quantitative Study.

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