Toulon Pierre, Ozier Yves, Ankri Annick, Fléron Marie-Hélène, Leroux Geneviève, Samama Charles Marc
CHU, Hôpital de Cimiez, Service d'Hématologie Biologique, 4 avenue de la Reine Victoria, BP 1179, F-06003 Nice Cedex 1, France.
Thromb Haemost. 2009 Feb;101(2):394-401.
Delay in collecting coagulation test results from a central laboratory is one of the critical issues to efficiently control haemostasis during surgery. The aim of this multicenter study was to compare the performance of a point-of-care (POC) device (CoaguChek Pro DM) with the central laboratory-based coagulation testing during haemorrhagic surgery. For this purpose, 93 patients undergoing major surgical procedure were prospectively included in three centers. Blood was drawn from all patients before surgical incision and from most patients during surgical procedure after a blood loss of 25% or more was observed. When expressed in activity percentage, POC-based prothrombin time (PT) was in good agreement with central laboratory test result with coefficient of correlation in the range from 0.711 to 0.960 in the three centers. Comparison was less conclusive when PT was expressed in seconds or as the patient-to-control ratio and for activated partial thromboplastin time, with significantly shorter clotting times and lower ratios obtained on the POC device. On-site PT (in activity percentage) monitoring would have induced no significant change in fresh frozen plasma (FFP) transfusion in patients when compared to central laboratory monitoring. Test results were obtained in less than 5 minutes when performed using the POC device versus a median turnaround time of 88 minutes (range: 29-235 minutes) when blood collection tubes were sent to the central laboratory. These results suggest that, in providing a rapid answer, POC-based monitoring of PT (in percentage) using the CoaguChek device could be validly used in patients undergoing haemorrhagic surgical procedures.
从中心实验室获取凝血检测结果的延迟是手术期间有效控制止血的关键问题之一。这项多中心研究的目的是比较即时检验（POC）设备（CoaguChek Pro DM）与中心实验室凝血检测在出血性手术中的性能。为此，三个中心前瞻性纳入了93例接受大手术的患者。在手术切口前从所有患者采集血液，在观察到失血25%或更多后，从大多数手术过程中的患者采集血液。以活性百分比表示时，基于POC的凝血酶原时间（PT）与中心实验室检测结果高度一致，三个中心的相关系数范围为0.711至0.960。当PT以秒或患者与对照比值表示时，以及对于活化部分凝血活酶时间，比较结果不太确定，POC设备上获得的凝血时间明显更短，比值更低。与中心实验室监测相比，现场PT（以活性百分比表示）监测不会导致患者新鲜冰冻血浆（FFP）输注有显著变化。使用POC设备进行检测时，不到5分钟即可获得检测结果，而将采血管送至中心实验室时，中位周转时间为88分钟（范围：29 - 235分钟）。这些结果表明，通过CoaguChek设备基于POC的PT（百分比）监测能够快速得出结果，可有效地用于接受出血性手术的患者。
