Beynon Christopher, Jakobs Martin, Rizos Timolaos, Unterberg Andreas W, Sakowitz Oliver W
Department of Neurosurgery, Heidelberg University Hospital , Heidelberg , Germany.
Br J Neurosurg. 2014 Jan;28(1):29-33. doi: 10.3109/02688697.2013.869549. Epub 2013 Dec 9.
With the increased use of oral anticoagulation with vitamin K antagonists, emergency physicians encounter a growing number of patients requiring a rapid reversal of anticoagulant effects in order to perform urgent surgical procedures. Initiation of these procedures can be delayed because the coagulation status has to be assessed through examination of blood samples in central laboratories (CL). This delay may lead to negative effects, especially in potentially life-threatening conditions such as intracranial haemorrhage. Point-of-care (POC) devices for assessment of international normalized ratio (POC INR) have improved the management of anticoagulation therapy in the outpatient setting. The use of these devices may also have beneficial effects in the treatment of anticoagulated patients requiring urgent neurosurgical procedures. The primary aim of this study was to analyse the potential of POC-guided assessment of INR to reduce time to potentially life-saving neurosurgery in this setting. Feasibility and accuracy as well as the gain of time through the use of this device were analysed.
The POC coagulometer CoaguChek XS(®) was used in 17 patients with a history of anticoagulant use and a condition requiring urgent anticoagulant reversal prior to neurosurgical procedures (burr-hole trepanation: n = 8, craniotomy: n = 7, laminectomy: n = 2).
No technical difficulties occurred and rapid assessment of INR was achieved in all cases within 2 min. POC INR values correlated well with CL INR assessment with a mean INR deviation of 0.036 ± 0.12. The mean gain of time through the use of the POC INR device compared with CL assessment of INR was 47 ± 6 min (range: 37-61 min).
Our initial experiences with a POC INR device in anticoagulated patients undergoing urgent neurosurgical procedures demonstrate that its use may contribute to an improved management of these patients.
随着维生素K拮抗剂在口服抗凝治疗中的使用增加，急诊医生遇到越来越多需要迅速逆转抗凝作用以便进行紧急外科手术的患者。由于必须通过中央实验室（CL）对血样进行检测来评估凝血状态，这些手术的启动可能会延迟。这种延迟可能会产生负面影响，尤其是在诸如颅内出血等潜在危及生命的情况下。用于评估国际标准化比值（即时检验国际标准化比值，POC INR）的即时检验（POC）设备改善了门诊抗凝治疗的管理。在治疗需要紧急神经外科手术的抗凝患者时，使用这些设备可能也有有益效果。本研究的主要目的是分析在这种情况下即时检验指导下的国际标准化比值评估对于缩短进行可能挽救生命的神经外科手术时间的潜力。分析了使用该设备的可行性、准确性以及时间节省情况。
对17例有抗凝用药史且在神经外科手术（钻孔开颅术：n = 8，开颅手术：n = 7，椎板切除术：n = 2）前需要紧急逆转抗凝作用的患者使用了即时检验凝血仪CoaguChek XS(®)。
未出现技术困难，所有病例均在2分钟内快速完成国际标准化比值评估。即时检验国际标准化比值值与中央实验室国际标准化比值评估结果相关性良好，平均国际标准化比值偏差为0.036±0.12。与中央实验室国际标准化比值评估相比，使用即时检验国际标准化比值设备平均节省时间47±6分钟（范围：37 - 61分钟）。
我们在使用即时检验国际标准化比值设备治疗接受紧急神经外科手术的抗凝患者方面的初步经验表明，其使用可能有助于改善对这些患者的管理。
