Document Detail

Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients.
MedLine Citation:
PMID:  22914710     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The current investigation aimed to study the efficacy of hemostatic therapy guided either by conventional coagulation analyses or point-of-care (POC) testing in coagulopathic cardiac surgery patients.
METHODS: Patients undergoing complex cardiac surgery were assessed for eligibility. Those patients in whom diffuse bleeding was diagnosed after heparin reversal or increased blood loss during the first 24 postoperative hours were enrolled and randomized to the conventional or POC group. Thromboelastometry and whole blood impedance aggregometry have been performed in the POC group. The primary outcome variable was the number of transfused units of packed erythrocytes during the first 24 h after inclusion. Secondary outcome variables included postoperative blood loss, use and costs of hemostatic therapy, and clinical outcome parameters. Sample size analysis revealed a sample size of at least 100 patients per group.
RESULTS: There were 152 patients who were screened for eligibility and 100 patients were enrolled in the study. After randomization of 50 patients to each group, a planned interim analysis revealed a significant difference in erythrocyte transfusion rate in the conventional compared with the POC group [5 (4;9) versus 3 (2;6) units [median (25 and 75 percentile)], P<0.001]. The study was terminated early. The secondary outcome parameters of fresh frozen plasma and platelet transfusion rates, postoperative mechanical ventilation time, length of intensive care unit stay, composite adverse events rate, costs of hemostatic therapy, and 6-month mortality were lower in the POC group.
CONCLUSIONS: Hemostatic therapy based on POC testing reduced patient exposure to allogenic blood products and provided significant benefits with respect to clinical outcomes.
Christian Friedrich Weber; Klaus Görlinger; Dirk Meininger; Eva Herrmann; Tobias Bingold; Anton Moritz; Lawrence H Cohn; Kai Zacharowski
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  117     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-23     Completed Date:  2012-11-01     Revised Date:  2013-04-26    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  531-47     Citation Subset:  AIM; IM    
Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital Frankfurt, Frankfurt am Main, Germany.
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MeSH Terms
Cardiac Surgical Procedures*
Cardiopulmonary Bypass
Erythrocyte Transfusion*
Factor VIIa / therapeutic use
Fibrinogen / therapeutic use
Hemostatics / therapeutic use*
Middle Aged
Point-of-Care Systems*
Prospective Studies
Reg. No./Substance:
0/Hemostatics; 9001-32-5/Fibrinogen; EC VIIa
Comment In:
Anesthesiology. 2013 Apr;118(4):988   [PMID:  23511529 ]
Anesthesiology. 2013 Apr;118(4):988-90   [PMID:  23511530 ]
Anesthesiology. 2013 Apr;118(4):987-8   [PMID:  23511528 ]

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