Tschaikowsky K, Balint R, Pscheidl E, Bremer F
Klinik für Anästhesiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Anaesthesist. 1998 Apr;47(4):295-302. doi: 10.1007/s001010050560.
Turnaround time for analysis of prothrombin time (PT) and activated partial thromboplastin time (APTT) by standard laboratory methods ranges between 40 min and several hours. The delay in obtaining the test results limits their clinical utility for treatment of perioperative coagulation disorders and adequate anti-coagulation therapy. In this study, we compared on-site coagulation testing (OCT) of whole blood, which takes about 3 min, with standard laboratory plasma coagulation tests by our institutional laboratory (LAB) to assess the accuracy of the OCT in a clinical setting (abdominal and postcardiac surgery).
PT of 62 patients with abdominal surgery was measured intra- and postoperatively using both LAB (KC 40, Thromborel S, Centeon) and OCT (CoaguChek Plus, Boehringer Mannheim) systems. APTT was determined by LAB-(KC 40, Pathromtin, Centeon) and OCT-methods in 53 patients who underwent cardiac surgery requiring cardiopulmonary bypass.
Linear regression demonstrated a strong and significant (p = 0.0001) correlation of OCT- and LAB-determinations both for PT (r = 0.92) and APTT (r = 0.91). For PT testing, bias analyses showed an agreement between OCT- and LAB-International Normalized Ratio (INR) (bias = 0.24; relative error = 14.6%) that was considered clinically acceptable, with 95% of the INR-differences lying between -0,26 and +0,74 (mean +/- 2 SD). Although commercial APTT-reagents usually differ in their sensitivity to heparin, we also found an acceptable agreement between OCT- and LAB-APTT values (bias = 6.7 s +/- 22 s; mean +/- 2 SD; relative error = 12%).
On-site coagulation monitoring provides a rapid, convenient, and accurate assessment of coagulation that can both guide specific anti-coagulation therapy and optimize therapy control of coagulation disorders after cardiac and abdominal operations. As a consequence, OCT offers a valuable tool to reduce the inappropriate use of fresh frozen plasma and to improve cost-effectiveness.
采用标准实验室方法分析凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）的周转时间在40分钟至数小时之间。获取检测结果的延迟限制了它们在围手术期凝血障碍治疗和适当抗凝治疗中的临床应用。在本研究中，我们将耗时约3分钟的全血现场凝血检测（OCT）与我们机构实验室（LAB）的标准实验室血浆凝血检测进行比较，以评估OCT在临床环境（腹部手术和心脏手术后）中的准确性。
使用LAB（KC 40、Thromborel S、Centeon）和OCT（CoaguChek Plus、Boehringer Mannheim）系统在62例腹部手术患者的术中及术后测量PT。在53例需要体外循环的心脏手术患者中，通过LAB（KC 40、Pathromtin、Centeon）和OCT方法测定APTT。
线性回归显示，OCT和LAB测定的PT（r = 0.92）和APTT（r = 0.91）之间存在强烈且显著（p = 0.0001）的相关性。对于PT检测，偏差分析显示OCT和LAB国际标准化比值（INR）之间具有临床可接受的一致性（偏差 = 0.24；相对误差 = 14.6%），95%的INR差值在-0.26至 +0.74之间（平均值±2标准差）。尽管商用APTT试剂对肝素的敏感性通常不同，但我们也发现OCT和LAB的APTT值之间具有可接受的一致性（偏差 = 6.7秒±22秒；平均值±2标准差；相对误差 = 12%）。
现场凝血监测可快速、方便且准确地评估凝血情况，既能指导特定的抗凝治疗，又能优化心脏和腹部手术后凝血障碍的治疗控制。因此，OCT为减少新鲜冰冻血浆的不当使用和提高成本效益提供了一个有价值的工具。
