Point-of-Care Testing

Weber, Christian Friedrich; Görlinger, Klaus; Meininger, Dirk; Herrmann, Eva; Bingold, Tobias M.; Moritz, Anton; Cohn, Lawrence H.; Zacharowski, Kai

doi:10.1097/aln.0b013e318264c644

Cited by 534 publications

(175 citation statements)

References 40 publications

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“…Fifteen trials that randomised a total of 8737 participants met the inclusion criteria and were included in the analysis. 112,129,[135][136][137][138][139][140][141][142][143][144][145][146][147] Two of the included studies were published in abstract form. 139,144 The two review authors (GJM, GFS) were in agreement on the selection of included studies.…”

Section: Resultsmentioning

confidence: 99%

“…[108][109][110][111] In consultation with clinical experts on the study team, and informed by the normal ranges and a published algorithm for ROTEM, 112 criteria were set to define positive test results and what treatments would be given as a result of positive tests. For TEG and ROTEM these values were approximately 80% of the normal ranges.…”

Section: Model Probabilities To 1 Year: Test-all Armmentioning

confidence: 99%

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Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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This report should be referenced as follows:Murphy GJ, Mumford AD, Rogers CA, Wordsworth S, Stokes EA, Verheyden V, et al. Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials. Programme Grants Appl Res 2017;5(17). Programme Grants for Applied ResearchISSN 2050-4322 (Print) ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10384. The contractual start date was in July 2008. The final report began editorial review in July 2016 and was accepted for publication in April 2017. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not ...

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Section: Resultsmentioning

confidence: 99%

Section: Model Probabilities To 1 Year: Test-all Armmentioning

confidence: 99%

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Murphy

Mumford

Rogers

et al. 2017

Programme Grants Appl Res

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“…The MEA platelet function analyzer ADP‐test and ASPI‐test results measures platelet dysfunction associated with P2Y 12 blockers and aspirin, respectively 28. The EXTEM maximum clot firmness ‐ FIBTEM maximum clot firmness and TRAP‐test results were selected to measure global platelet dysfunction function 11, 16. Test results were incorporated into predictive models for CCB as continuous variable.…”

Section: Methodsmentioning

confidence: 99%

“…Several small, single‐center, randomized controlled trials (RCTs) in cardiac surgery have shown that when compared to conventional laboratory testing or clinician judgement alone, near‐patient testing reduced transfusion of RBC10, 11 or non‐RBC blood components 10, 11, 12, 13, 14, 15. In a multicenter RCT of more than 7400 patients, implementation of a blood management algorithm incorporating near‐patient tests, resulted in reduced RBC transfusion, platelet transfusion and overall bleeding 16.…”

Section: Introductionmentioning

confidence: 99%

“…This is an attractive clinical strategy since identification of patients at the highest risk of bleeding could potentially enable selective targeted treatments to prevent severe bleeding starting. Predictive near‐patient testing has been incorporated into several blood management algorithms evaluated in several previous RCTs, usually as a single step for selection of preventative treatments10, 12, 13, 15 or in combination with later diagnostic near‐patient testing in patients who develop bleeding despite preventative treatments 11…”

Section: Introductionmentioning

confidence: 99%

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Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Mumford

Harris

Plummer

et al. 2017

Research and Practice in Thrombosis and Haemostasis

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Essentials Near‐patient testing improves coagulopathy diagnosis in cardiac surgery patients with severe bleeding.We investigated how well pre‐emptive near‐patient testing predicted severe bleeding.Severe bleeding could be predicted using both near‐patient tests and patient clinical characteristics.Near‐patient test results gave little additional predictive value over clinical characteristics alone. BackgroundCoagulopathic bleeding is common after cardiac surgery and is associated with increased morbidity, mortality and healthcare costs. Implementation of blood management algorithms in which patients with severe bleeding undergo near‐patient coagulation testing results in less overall bleeding and transfusion. However, it is unknown whether there is additional value from pre‐emptive near‐patient testing to predict whether severe bleeding will occur.ObjectivesTo evaluate how well a comprehensive panel of 28 near‐patient platelet and viscoelastometry tests predict bleeding after cardiac surgery, compared to prediction using baseline clinical characteristics alone.MethodsSingle‐center, prospective cohort study in adults undergoing a range of cardiac surgery procedures. The primary outcome was clinical concern about bleeding (CCB), a composite of high blood loss (chest drain volume >600 mL within 6 hours), re‐operation for bleeding or administration of a pro‐haemostatic treatment directed by clinician judgement.ResultsIn 1833 patients recruited between March 2010 and August 2012, the median number of abnormal near‐patient test results was 5/28 per patient (range 0‐18). CCB occurred in 449/1833 patients (24.5%). The c‐statistic for a predictive model for CCB using only baseline clinical characteristics (baseline‐only model) was 0.72 (95% CI 0.69‐0.75). Addition of near‐patient test results to this model (baseline‐plus‐test model) improved the prediction of CCB (c‐statistic 0.75 [0.72‐0.77]), but increased the number of correctly classified patients by only 18 (0.98%).ConclusionsNear‐patient coagulation testing predicts bleeding in cardiac surgery patients, but offers little improvement in prediction compared to baseline clinical characteristics alone. trial registration: ISRNCTN 20778544 (http://www.isrctn.com/).

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Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding

Wikkelsø

Wetterslev

Møller

et al. 2016

Cochrane Database of Systematic Reviews

292

294

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Point-of-Care Testing

Abstract: Hemostatic therapy based on POC testing reduced patient exposure to allogenic blood products and provided significant benefits with respect to clinical outcomes.

Cited by 534 publications

References 40 publications

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Diagnostic and therapeutic medical devices for safer blood management in cardiac surgery: systematic reviews, observational studies and randomised controlled trials

Near‐patient coagulation testing to predict bleeding after cardiac surgery: a cohort study

Thromboelastography (TEG) or thromboelastometry (ROTEM) to monitor haemostatic treatment versus usual care in adults or children with bleeding

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