Meesters Michael I, Vonk Alexander B A, van de Weerdt Emma K, Kamminga Suzanne, Boer Christa
Department of Anesthesiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
Department of Cardio-thoracic Surgery, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
Thromb Res. 2014 Jun;133(6):1141-4. doi: 10.1016/j.thromres.2014.03.030. Epub 2014 Mar 21.
Hemostasis monitoring in cardiac surgery could benefit from an easy to use and fast point-of-care coagulation monitor, since routine laboratory tests have a delay of 30-45minutes. This study investigated the level of agreement between the point-of-care prothrombin time (PT) with central laboratory PT before and after cardiopulmonary bypass.
Bland Altman and error grid analysis were used to analyze the agreement between the point-of-care Coaguchek XS Pro device (POC-PT) and the central laboratory prothrombin time (LAB-PT) before cardiopulmonary bypass (CPB) and 3minutes after protamine administration. Prothrombin times were expressed in international normalized ratios (INR).
The average POC-PT and LAB-PT values of 73 patients were 1.06±0.14 and 1.09±0.13 (P=0.10) before CPB. POC-PT measurements before CPB showed a good agreement with the LAB-PT, with a bias of -0.02±0.07 INR and 94% of the values being represented in the clinical acceptable zone of error grid analysis. The mean POC-PT 3minutes after protamine administration was significantly lower than the LAB-PT (1.35±0.12 vs. 1.70±0.18; P<0.001). The PT at 3minutes after protamine administration showed a bias of 0.36±0.14, and 82% of the values were located outside of the clinical acceptable zone in the error grid analysis.
Point-of-care prothrombin time testing was in concordance with conventional laboratory PT prior to cardiopulmonary bypass. At 3minutes following protamine administration, PT values of the point-of-care device were structurally lower than the laboratory PT values, leading to a disagreement between both tests at that time point.
心脏手术中的止血监测可受益于一种易于使用且快速的即时凝血监测仪，因为常规实验室检测会有30 - 45分钟的延迟。本研究调查了体外循环前后即时凝血酶原时间（PT）与中心实验室PT之间的一致性水平。
采用Bland Altman分析和误差网格分析来分析即时凝血检测设备Coaguchek XS Pro（即时PT）与中心实验室凝血酶原时间（实验室PT）在体外循环（CPB）前及鱼精蛋白给药后3分钟的一致性。凝血酶原时间以国际标准化比值（INR）表示。
73例患者在CPB前即时PT和实验室PT的平均值分别为1.06±0.14和1.09±0.13（P = 0.10）。CPB前即时PT测量值与实验室PT显示出良好的一致性，偏差为 -0.02±0.07 INR，94%的值落在误差网格分析的临床可接受区域内。鱼精蛋白给药后3分钟时即时PT的平均值显著低于实验室PT（1.35±0.12对1.70±0.18；P < 0.001）。鱼精蛋白给药后3分钟时的PT偏差为0.36±0.14，误差网格分析中82%的值位于临床可接受区域之外。
即时凝血酶原时间检测在体外循环前与传统实验室PT一致。鱼精蛋白给药后3分钟时，即时检测设备的PT值在结构上低于实验室PT值，导致此时两种检测结果不一致。
