The surgical application of point-of-care haemostasis and platelet function testing

Dickinson, Karen J.; Troxler, M; Homer‐Vanniasinkam, Shervanthi

doi:10.1002/bjs.6359

Cited by 25 publications

(16 citation statements)

References 106 publications

(109 reference statements)

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“…Detecting platelet dysfunction may provide clinical insight into contributing factors for SDH, particularly when spontaneous and multiple. The results may also guide peri-operative management [6,11,15,16]. In SDH patients with abnormal PFA, we withheld antiplatelet agents peri-operatively until post-operative scans showed SDH resolution.…”

Section: Discussionmentioning

confidence: 97%

“…As the bleeding test proved difficult to standardize, most hospitals no longer perform this simple test. In place of bleeding times, platelet function assays (PFA) have become commercially available [13][14][15][16] including platelet aggregometry, the Rapid-Platelet-Function-Analyzer, flow cytometry, and the PFA 100. One of these assays, the PFA 100 assay aspirates whole blood samples under high-shear stress conditions through a cartridge coated with collagen/epinephrine or collagen/ adenosine diphosphate (ADP).…”

Section: Introductionmentioning

confidence: 99%

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Slippery Platelet Syndromes in Subdural Hematoma

et al. 2010

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Slippery Platelet Syndromes in Subdural Hematoma

et al. 2010

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“…46,76, These articles report the findings of 108 studies that are detailed in the subsequent sections of this report. The remaining 15 articles [203][204][205][206][207][208][209][210][211][212][213][214][215][216][217] reported systematic reviews and these are described below (see Systematic reviews).…”

Section: Quantity Of Research Availablementioning

confidence: 99%

“…[203][204][205][206][207][208][209][210][211][212][213][214][215][216][217] On more detailed scrutiny, two reviews did not link the results of PFTs to clinical outcomes (one review on pharmacogenetics 203 and one on the role of PFTs in guiding clinical practice which did not provide prospective follow-up of clinical outcomes 204 ). A further review 205 was predominantly focused on patients with renal insufficiency and therefore is not discussed further.…”

Section: Systematic Reviewsmentioning

confidence: 99%

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

Dretzke

Riley

Lordkipanidzé

et al. 2015

Health Technology Assessment

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BackgroundThe use of aspirin is well established for secondary prevention of cardiovascular disease. However, a proportion of patients suffer repeat cardiovascular events despite being prescribed aspirin treatment. It is uncertain whether or not this is due to an inherent inability of aspirin to sufficiently modify platelet activity. This report aims to investigate whether or not insufficient platelet function inhibition by aspirin (‘aspirin resistance‘), as defined using platelet function tests (PFTs), is linked to the occurrence of adverse clinical outcomes, and further, whether or not patients at risk of future adverse clinical events can be identified through PFTs.ObjectivesTo review systematically the clinical effectiveness and cost-effectiveness evidence regarding the association between PFT designation of ‘aspirin resistance’ and the risk of adverse clinical outcome(s) in patients prescribed aspirin therapy. To undertake exploratory model-based cost-effectiveness analysis on the use of PFTs.Data sourcesBibliographic databases (e.g. MEDLINE from inception and EMBASE from 1980), conference proceedings and ongoing trial registries up to April 2012.MethodsStandard systematic review methods were used for identifying clinical and cost studies. A risk-of-bias assessment tool was adapted from checklists for prognostic and diagnostic studies. (Un)adjusted odds and hazard ratios for the association between ‘aspirin resistance’, for different PFTs, and clinical outcomes are presented; however, heterogeneity between studies precluded pooling of results. A speculative economic model of a PFT and change of therapy strategy was developed.ResultsOne hundred and eight relevant studies using a variety of PFTs, 58 in patients on aspirin monotherapy, were analysed in detail. Results indicated that some PFTs may have some prognostic utility, i.e. a trend for more clinical events to be associated with groups classified as ‘aspirin resistant’. Methodological and clinical heterogeneity prevented a quantitative summary of prognostic effect. Study-level effect sizes were generally small and absolute outcome risk was not substantially different between ‘aspirin resistant’ and ‘aspirin sensitive’ designations.No studies on the cost-effectiveness of PFTs for ‘aspirin resistance’ were identified. Based on assumptions of PFTs being able to accurately identify patients at high risk of clinical events and such patients benefiting from treatment modification, the economic model found that a test–treat strategy was likely to be cost-effective. However, neither assumption is currently evidence based.LimitationsPoor or incomplete reporting of studies suggests a potentially large volume of inaccessible data. Analyses were confined to studies on patients prescribed aspirin as sole antiplatelet therapy at the time of PFT. Clinical and methodological heterogeneity across studies precluded meta-analysis. Given the lack of robust data the economic modelling was speculative.ConclusionsAlthough evidence indicates that some PFTs may have some prognostic value, methodological and clinical heterogeneity between studies and different approaches to analyses create confusion and inconsistency in prognostic results, and prevented a quantitative summary of their prognostic effect. Protocol-driven and adequately powered primary studies are needed, using standardised methods of measurements to evaluate the prognostic ability of each test in the same population(s), and ideally presenting individual patient data. For any PFT to inform individual risk prediction, it will likely need to be considered in combination with other prognostic factors, within a prognostic model.Study registrationThis study is registered as PROSPERO 2012:CRD42012002151.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Moreover, they are not informative as far as clot stability and fibrinolysis are concerned. Recently, there has been a growing interest in the use of whole blood point-of-care devices, namely thromboelastometry/graphy, in the study of perioperative coagulopathies [8]. These devices are able to record the viscoelastic changes occurring during clot formation, stabilization and lysis.…”

Section: Introductionmentioning

confidence: 99%

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

et al. 2016

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Traditional coagulative parameters are of limited use in identifying perioperative coagulopathy occurring in patients undergoing major elective orthopedic surgery (MEOS). The aim of our study was to evaluate the coagulation changes in patients undergoing MEOS and to facilitate an early detection of perioperative coagulopathy in patients experiencing major intraoperative bleeding. We enrolled 40 consecutive patients (M/F 10/30, age range 34-90 years) who underwent MEOS at the Orthopedic Unit of the Padua University Hospital, Italy, between January 2014 and January 2015. Blood samples were obtained at the following time points: T0-pre: 30 min before surgery; T0-post: 30 min after the end of the procedure; T1: morning of the first postoperative day; T2: 7 ± 2 days after surgery. Patients who experienced an intraoperative blood loss ≥250 mL/h were considered as cases. Routine coagulative parameters, thromboelastometry and thrombin generation (TG) profiles were evaluated. At baseline, a significantly lower platelet count and FIBTEM MCF/AUC were observed in patents with excessive bleeding (p < 0.05 and 0.02/0.01, respectively). At T0-post and T1 intervals, cases showed hypocoagulation characterized by a significantly low platelet count (p = 0.001), prolonged CFT INTEM/EXTEM, reduction of alpha-angle and MaxV INTEM/EXTEM, MCF and AUC INTEM/EXTEM/FIBTEM (p < 0.05 in all comparisons). The only TG parameter standing out between study groups was time to peak at T0-pre. A low platelet count and fibrinogen activity were associated with significant intraoperative bleeding in patients undergoing MEOS. Thromboelastometry performed by ROTEM(®) identifies patients with coagulopathy.

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The surgical application of point-of-care haemostasis and platelet function testing

Abstract: POC haemostasis testing is a growing field in surgical practice. Such testing can be correlated with improved clinical outcome.

Cited by 25 publications

References 106 publications

Slippery Platelet Syndromes in Subdural Hematoma

Slippery Platelet Syndromes in Subdural Hematoma

The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

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