Boldt J, Walz G, Triem J, Suttner S, Kumle B
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Germany.
Intensive Care Med. 1998 Nov;24(11):1187-93. doi: 10.1007/s001340050743.
Two different point-of-care (POC) systems for the monitoring of coagulation variables at the bedside were evaluated with regard to practicability, accuracy and costs.
Prospective, descriptive study.
Single-institutional, clinical investigation on an intensive care unit (ICU) of an urban, university-affiliated hospital.
Eighty cardiac surgery patients were studied postoperatively.
Arterial blood samples were drawn postoperatively on the ICU at different data points.
Activated partial thromboplastin time (aPTT) and prothrombin time (PT) were measured using two POC systems (Thrombolytic Assessment System [TAS] and CoaguCheck Plus). At the same time coagulation parameters were measured by the central laboratory of the hospital. Measurements were carried out at different data points after cardiac surgery on the ICU. The direct and indirect costs of measuring aPTT/PT were also assessed. Bias analyses revealed good agreement of the POC-based monitoring of aPTT/PT with laboratory-based monitoring of coagulation (e. g. aPTT CoaguCheck: bias of -2.8 s with +/- 2 SD [limits of agreement] of +13.7 and -19.1 s). Mean turn-around time (TAT; time from blood sampling until availability of data for the ICU physicians) was significantly longer for the central laboratory-based coagulation monitoring (130 +/- 38 min) than for the two POC systems (aPTT-TAS: 9.6 +/- 2.7 min; aPTT-CoaguCheck: 6.5 +/- 1.9 min). Blood sampling at unfavorable times increased the TAT for laboratory-based measurements considerably. The direct costs for measuring aPPT and PT were significantly higher using both POC systems (aPTT-TAS: $4.84; aPTT-CoaguCheck: $4.34) than for the central laboratory ($1.59). Costs for transportation increased the laboratory-based monitoring considerably ($3.77).
Both POC analyzers may reduce the potential for preanalytical errors associated with coagulation measurements at the central laboratory, hasten TAT significantly and may improve patient therapy by reducing inappropriate administration of blood products.
对两种用于床边凝血指标监测的即时检验（POC）系统的实用性、准确性和成本进行评估。
前瞻性描述性研究。
一所城市大学附属医院重症监护病房（ICU）的单机构临床研究。
80例心脏手术患者术后接受研究。
术后在ICU不同时间点采集动脉血样。
使用两种POC系统（溶栓评估系统 [TAS] 和CoaguCheck Plus）测量活化部分凝血活酶时间（aPTT）和凝血酶原时间（PT）。同时由医院中心实验室测量凝血参数。在ICU对心脏手术后不同时间点进行测量。还评估了测量aPTT/PT的直接和间接成本。偏差分析显示基于POC的aPTT/PT监测与基于实验室的凝血监测具有良好的一致性（例如，CoaguCheck的aPTT：偏差为 -2.8秒，+/- 2标准差 [一致性界限] 为 +13.7和 -19.1秒）。基于中心实验室的凝血监测的平均周转时间（TAT；从采血到ICU医生获得数据的时间）（130 +/- 38分钟）明显长于两种POC系统（aPTT-TAS：9.6 +/- 2.7分钟；aPTT-CoaguCheck：6.5 +/- 1.9分钟）。在不利时间采血会显著增加基于实验室测量的TAT。使用两种POC系统测量aPPT和PT的直接成本（aPTT-TAS：4.84美元；aPTT-CoaguCheck：4.34美元）均显著高于中心实验室（1.59美元）。运输成本显著增加了基于实验室的监测成本（3.77美元）。
两种POC分析仪均可减少与中心实验室凝血测量相关的分析前误差可能性，显著加快TAT，并可能通过减少血液制品的不当使用来改善患者治疗。
