Mackenzie C J, McGowan C M, Pinchbeck G, Carslake H B
Department of Equine Clinical Science, University of Liverpool, Institute of Veterinary Science, Neston, Cheshire, UK.
Department of Epidemiology and Population Health, University of Liverpool, Institute of Infection and Global Health, Neston, Cheshire, UK.
Equine Vet J. 2018 May;50(3):333-338. doi: 10.1111/evj.12764. Epub 2017 Nov 2.
Evaluation of coagulation status is an important component of critical care. Ongoing monitoring of coagulation status in hospitalised horses has previously been via serial venipuncture due to concerns that sampling directly from the intravenous catheter (IVC) may alter the accuracy of the results. Adverse effects such as patient anxiety and trauma to the sampled vessel could be avoided by the use of an indwelling IVC for repeat blood sampling.
To compare coagulation parameters from blood obtained by jugular venipuncture with IVC sampling in critically ill horses.
Prospective observational study.
A single set of paired blood samples were obtained from horses (n = 55) admitted to an intensive care unit by direct jugular venipuncture and, following removal of a presample, via an indwelling IVC. The following coagulation parameters were measured on venipuncture and IVC samples: whole blood prothrombin time (PT), fresh plasma PT and activated partial thromboplastin time (aPTT) and stored plasma antithrombin activity (AT) and fibrinogen concentration. D-dimer concentration was also measured in some horses (n = 22). Comparison of venipuncture and IVC results was performed using Lin's concordance correlation coefficient. Agreement between paired results was assessed using Bland Altman analysis.
Correlation was substantial and agreement was good between sample methods for all parameters except AT and D-dimers.
Each coagulation parameter was tested using only one assay. Sampling was limited to a convenience sample and timing of sample collection was not standardised in relation to when the catheter was flushed with heparinised saline.
With the exception of AT and D-dimers, coagulation parameters measured on blood samples obtained via an IVC have clinically equivalent values to those obtained by jugular venipuncture.
凝血状态评估是重症监护的重要组成部分。由于担心直接从静脉导管（IVC）采样可能会改变结果的准确性，此前对住院马匹凝血状态的持续监测一直是通过连续静脉穿刺进行的。使用留置IVC进行重复采血可以避免诸如患者焦虑和对采样血管造成创伤等不良反应。
比较重症马匹通过颈静脉穿刺采血与通过IVC采样获得的血液的凝血参数。
前瞻性观察性研究。
从入住重症监护病房的马匹（n = 55）中，通过直接颈静脉穿刺采集一组配对血样，在采集预样本后，再通过留置IVC采集血样。对静脉穿刺血样和IVC血样测量以下凝血参数：全血凝血酶原时间（PT）、新鲜血浆PT、活化部分凝血活酶时间（aPTT）以及储存血浆抗凝血酶活性（AT）和纤维蛋白原浓度。还对部分马匹（n = 22）测量了D - 二聚体浓度。使用林氏一致性相关系数对静脉穿刺和IVC结果进行比较。使用布兰德 - 奥特曼分析评估配对结果之间的一致性。
除AT和D - 二聚体外，所有参数的样本采集方法之间相关性显著且一致性良好。
每个凝血参数仅使用一种检测方法进行检测。采样仅限于便利样本，且样本采集时间相对于用肝素盐水冲洗导管的时间未标准化。
除AT和D - 二聚体外，通过IVC采集的血样所测得的凝血参数在临床上与通过颈静脉穿刺获得的参数具有等效值。
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