Aggarwal Vikram, Kapoor Poonam Malhotra, Choudhury Minati, Kiran Usha, Chowdhury Ujjwal
Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
Ann Card Anaesth. 2012 Jan-Mar;15(1):26-31. doi: 10.4103/0971-9784.91477.
Sonoclot analysis is a point of care test to monitor the coagulation process, presenting a comprehensive evaluation of the clot formation and retraction as well as platelet function. This randomized double-blinded study was designed to investigate the utility of Sonoclot analysis in monitoring the coagulation profile as also the antifibrinolytic effects of tranexamic acid administered in patients with tetralogy of Fallot undergoing intracardiac repair. Eighty of a total 94 patients were randomly divided into two groups of 40 each. In the study group, TA was administered thrice at a dosage of 10 mg/kg, i.e. before CPB, on CPB and after CPB, whereas in the control group, placebo was administered at the same time intervals. Sonoclot analysis and D-dimer measurement were performed at baseline and following heparin neutralisation. An additional variable, DR₁₅ (diminishing rate of clot strength at 15 min postmaximal clot strength), was calculated from the Sonoclot graph and was compared with d-dimer levels as a measure of fibrinolysis. The three Sonoclot variables, i.e. activated clotting time, clot rate and platelet function, were deranged at baseline in all the patients. Post-CPB, the change in these variables was not significant. ACT, clot rate and platelet function showed no significant (P > 0.05) difference in both the groups at both the time intervals. DR₁₅ and d-dimer values were comparable at baseline in both the groups. However, a significant (P < 0.05) difference was seen in these variables in the control group as compared with the TA group following heparin neutralisation. To conclude, Sonoclot analysis is a useful, point of care method for the monitoring of coagulation and fibrinolysis in patients with tetralogy of Fallot undergoing intracardiac repair.
Sonoclot分析是一种用于监测凝血过程的即时检验，可对血栓形成、回缩以及血小板功能进行全面评估。本随机双盲研究旨在探讨Sonoclot分析在监测法洛四联症患者心脏内修复术中凝血情况以及氨甲环酸抗纤溶作用方面的效用。94例患者中的80例被随机分为两组，每组40例。研究组在体外循环前、体外循环中及体外循环后以10mg/kg的剂量三次给予氨甲环酸，而对照组在相同时间间隔给予安慰剂。在基线期及肝素中和后进行Sonoclot分析和D - 二聚体测量。从Sonoclot图计算出另一个变量DR₁₅（最大凝血强度后15分钟时凝血强度的递减率），并将其与D - 二聚体水平进行比较，作为纤溶的指标。所有患者的三个Sonoclot变量，即活化凝血时间、凝血速率和血小板功能在基线期均紊乱。体外循环后，这些变量的变化不显著。在两个时间间隔，两组的活化凝血时间、凝血速率和血小板功能均无显著（P>0.05）差异。两组在基线期的DR₁₅和D - 二聚体值具有可比性。然而，肝素中和后，对照组与氨甲环酸组相比，这些变量存在显著（P<0.05）差异。总之，Sonoclot分析是一种用于监测法洛四联症患者心脏内修复术中凝血和纤溶的有用的即时检验方法。
