REVIEW   Free access

Minerva Anestesiologica 2022 July-August;88(7-8):615-28

DOI: 10.23736/S0375-9393.22.16380-7

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Point of care coagulation management in anesthesiology and critical care

Lars HEUBNER ¹ ✉, Martin MIRUS ¹, Oliver VICENT ¹, Andreas GÜLDNER ¹, Oliver TIEBEL ², Jan BEYER-WESTENDORF ³, Dietmar FRIES ⁴, Peter M. SPIETH ¹

¹ Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany; ² Institute of Clinical Chemistry, Carl Gustav Carus University Hospital, Dresden, Germany; ³ Unit of Thrombosis Research, Division of Hematology and Hemostasis, Department of Medicine I, Carl Gustav Carus University Hospital, Dresden, Germany; ⁴ Department for General and Surgical Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria

Point of care (POC) devices are increasingly used in the ICU and in anesthesia. Besides POC-devices for blood gas analysis, several devices are available for coagulation measurements. Although basic principles for thromboelastographic measurements are not novel, some promising developments were made during the last decade improving both user-friendliness and measurement reliability. For instance, POC measurements of activated clotting time (ACT) for heparin monitoring is still regarded as standard-of-care in cardiac interventions and surgery. In the field of anesthesia and intensive care medicine, POC-devices for thromboelastographic and platelet aggregation measurements are widely used. Their impact in case of bleeding and patient blood management for cardiothoracic and trauma surgery is well known. Moreover, there are promising concepts for anticoagulation monitoring including new oral anticoagulant drugs. Coagulation POC-devices may also identify patients at specific risk for thromboembolic events quickly. On the other hand, benefits of POC-devices need to be balanced against limitations, which include technical restrictions and operator related errors, mainly affecting reproducibility and interpretation of results. Therefore, it is recommendable to consider results of POC-coagulation testing in comparison to standard laboratory tests (SLT). Nevertheless, in urgent or emergency situations POC results enable fast decision making to optimize patient care.

KEY WORDS: Blood coagulation; Point-of-care systems; Thromboelastography