Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function

Stafford, Marshall; Weitzel, Nathaen

doi:10.1002/ddr.21099

Cited by 3 publications

(3 citation statements)

References 83 publications

(99 reference statements)

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“…This level is considered a cut-off for strong inhibition of COX-1 by aspirin [ 22 ]. The ASPItest is confirmed to be a reliable tool in aspirin resistance diagnosis [ 23 – 26 ]. A high frequency (34%) of aspirin resistance in heart transplantation recipients was found in the present study.…”

Section: Discussionmentioning

confidence: 99%

The incidence of aspirin resistance in heart transplantation recipients

Urbanowicz

Komosa

Michalak

et al. 2017

kitp

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IntroductionCoronary allograft vasculopathy can cause as many deaths as infections or rejection episodes within 3 years following heart transplantation.AimTo compare the aspirin resistance rate in an allograft heart transplantation population and in a control group by laboratory tests including the Aspirin-Resistant Patients Identification Test (ASPItest).Material and methodsA total of 24 heart recipients (20 men and 4 women) at a mean age of 48 ±13 years who underwent routine clinical follow-up were consecutively enrolled in group 1. The control group consisted of 24 patients (19 men and 5 women) at a mean age of 64 ±7 years waiting for coronary artery bypass grafting in our department. All patients were treated with a standard dose of 75 mg aspirin (ASA) daily.ResultsAspirin resistance was evaluated by the Multiplate platelet function test. The ASPItest revealed a mean value of 27 ±22 U in the transplant group. Results above 30 U were obtained in 8 (34%) patients, with a mean value of 50.3 ±20.6 U, indicating aspirin resistance. In the control group ASPItest results above 30 U were obtained in 5 (20%) patients, with a mean value of 43.3 ±6.4 U.ConclusionsThere is a high incidence (34% vs. 20%, NS) of ASA resistance in heart transplantation recipients and in the general population, respectively.

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Section: Discussionmentioning

confidence: 99%

The incidence of aspirin resistance in heart transplantation recipients

Urbanowicz

Komosa

Michalak

et al. 2017

kitp

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“…Furthermore, Sonoclot allows rapid identification of platelet dysfunctions, which are associated with increased mortality in patients with coagulopathy [16,17]. Recently, results obtained from animal experiments and in our large patient cohort have suggested that alterations in hemostasis might be detected by Sonoclot and predicted coagulation dysfunction in patients with overt DIC.…”

Section: Introductionmentioning

confidence: 95%

Sonoclot coagulation analysis

Wan

Qian

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Disseminated intravascular coagulation (DIC) contributes to high mortality. The study was performed to investigate Sonoclot as a potential predictor of 30-day survival in overt DIC. This cohort included 237 consecutive critically ill patients with overt DIC, admitted to a 15-bed multidisciplinary ICU between July 2010 and July 2013. Hemostasis was analyzed with Sonoclot, including activated clotting time (ACT), clot rate, and platelet function, as well as routine clotting test at admission to the critical care center. Sonoclot variables differed in survivors and nonsurvivors. Mean ACT was prolonged (289.9 ± 200.5 vs. 194.8 ± 126.6 s; P < 0.001) and platelet function (1.2 ± 0.9 vs. 1.6 ± 1.2; P = 0.010) was reduced in nonsurvivors. The clot rate was not different. Cox proportional-hazard model showed that ACT and platelet function correlated independently with survival (P < 0.05). Kaplan-Meier survival curve analysis suggested that patients with one pathological Sonoclot findings have better outcome (P < 0.05). After ACT and platelet function were introduced, the receiver-operating characteristic area under the curve of model achieved 0.876 (P < 0.05), with a specificity of 82.6% and a sensitivity of 80.5% in prediction of 30-day survival by multivariate analyses. Our data suggest that the Sonoclot can predict mortality in critically ill patients with overt DIC.

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“…Thromboelastography (TEG; ROTEM, TEM Innovations, Munich, Germany) is used to assess clot formation, including the kinetics of clotting, clot strength, and lysis that involves globally platelet function and coagulation [Scharbert et al., 2009 ; Stafford and Weitzel, 2013 ]. This test has been traditionally used in the surgical setting as a screen for bleeding risk.…”

Section: Platelet Function Tests and Their Utilitymentioning

confidence: 99%

The Utility of Platelet and Coagulation Testing of Antithrombotics: Fusing Science with Patient Care

Jennings

Kotha

2013

Drug Development Research

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Strategy, Management and Health PolicyEnabling Technology, Genomics, ProteomicsPreclinical ResearchPreclinical Development Toxicology, Formulation Drug Delivery, PharmacokineticsClinical Development Phases I-III Regulatory, Quality, ManufacturingPostmarketing Phase IV There is an increasing need for the standardization of platelet function and coagulation testing for the assessment of antithrombotic therapies. Investigators continue to strive to identify ideal laboratory testing and monitoring procedures for acquired and inherited platelet function defects as well as for evaluating patient status when treated with existing or emerging antithrombotics. These therapies are used primarily in the treatment of ischemic complications. In patients receiving antithrombotic therapy, the balance between hemostasis and thrombosis is a challenge as there is an ongoing risk for bleeding when patients are receiving antiplatelet agents or anticoagulants to lessen their risk for secondary thrombotic events. There are several diverse tests for monitoring anticoagulant therapy; however, as new agents are developed, more specific tests will be required to directly assess these agents in relationship to overall coagulation status. Research in the platelet biology field is ongoing to provide point-of-care methodologies for the assessment of platelet reactivity in terms of both bleeding and thrombosis risk. Currently there are no instruments that reliably assess the risk of bleeding. The challenges that routinely faced are the complexity of physiology, the need for standardization of platelet testing methodology, and the necessity for appropriate interpretation of the test results.

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Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function

Cited by 3 publications

References 83 publications

The incidence of aspirin resistance in heart transplantation recipients

The incidence of aspirin resistance in heart transplantation recipients

Sonoclot coagulation analysis

The Utility of Platelet and Coagulation Testing of Antithrombotics: Fusing Science with Patient Care

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