Institution of Clinical Science, Medical Faculty, Lund University, S-22185 Lund, Sweden.
Institution of Clinical Science, Medical Faculty, Lund University, S-22185 Lund, Sweden; Department of Anaesthesiology and Intensive Care, Skane University Hospital, 22185 Lund, Sweden.
Thromb Res. 2017 Aug;156:73-79. doi: 10.1016/j.thromres.2017.05.033. Epub 2017 Jun 3.
Previous viscoelastic haemostatic tests studies have often indicated a hypercoagulative test signal with citrated blood, which could influence clinical decision makings.
The aim of this study was to compare fresh and citrated whole blood using two non-automated viscoelastic ROTEM and Sonoclot tests. Our hypothesis was that citrated blood would demonstrate a hypercoagulative response in this setting, not tested before.
Perioperative viscoelastic coagulation changes were evaluated with a ROTEM and Sonoclot in 38 patients undergoing elective brain tumor surgery. The citrated samples were recalcified with CaCl. Wilcoxon nonparametric-paired tests and Bland-Altman plots were performed to compare the fresh and citrated blood analyses.
The citrated blood showed a hypercoagulative response in ROTEM NATEM-clot formation time and α-angle, Sonoclot-clot rate and platelet function, as compared to fresh blood (p<0.0001).
Fresh whole blood may theoretically reflect in vivo haemostasis more closely than citrated analyses, which indicated a hypercoagulative response as compared to the fresh whole blood analyses Bland-Altman plots also indicated that ROTEM reference ranges in patients undergoing brain surgery should be redefined. Future studies must establish the correlation between viscoelastic test results using fresh or citrate anticoagulated blood and clinical outcomes, such as bleeding, transfusion or reoperation for postoperative haematoma.
先前的黏弹性止血测试研究经常表明枸橼酸盐血液存在高凝测试信号，这可能会影响临床决策。
本研究旨在使用两种非自动化的黏弹性 ROTEM 和 Sonoclot 测试比较新鲜全血和枸橼酸盐全血。我们的假设是，在这种情况下，枸橼酸盐血液将表现出高凝反应，这是以前未测试过的。
对 38 例行择期脑肿瘤手术的患者进行围手术期黏弹性凝血变化评估，使用 ROTEM 和 Sonoclot。将枸橼酸盐样本用 CaCl 重新钙化。采用 Wilcoxon 非参数配对检验和 Bland-Altman 图比较新鲜和枸橼酸盐血液分析。
与新鲜血液相比，枸橼酸盐血液在 ROTEM NATEM-凝块形成时间和α角、Sonoclot-凝块速率和血小板功能方面表现出高凝反应（p<0.0001）。
与枸橼酸盐分析相比，新鲜全血理论上可能更能反映体内止血情况，其表现出高凝反应。Bland-Altman 图还表明，接受脑部手术的患者 ROTEM 参考范围应重新定义。未来的研究必须确定使用新鲜或枸橼酸盐抗凝血液的黏弹性测试结果与出血、输血或术后血肿再次手术等临床结果之间的相关性。
