Point of Care Testing in Cardiac Surgery: Diagnostic Modalities to Assess Coagulation and Platelet Function: Point of Care Testing in Cardiac Surgery

Sonoclot coagulation analysis: a useful tool to predict mortality in overt disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) contributes to high mortality. The study was performed to investigate Sonoclot as a potential predictor of 30-day survival in overt DIC. This cohort included 237 consecutive critically ill patients with overt DIC, admitted to a 15-bed multidisciplinary ICU between July 2010 and July 2013. Hemostasis was analyzed with Sonoclot, including activated clotting time (ACT), clot rate, and platelet function, as well as routine clotting test at admission to the critical care center. Sonoclot variables differed in survivors and nonsurvivors. Mean ACT was prolonged (289.9 ± 200.5 vs. 194.8 ± 126.6 s; P < 0.001) and platelet function (1.2 ± 0.9 vs. 1.6 ± 1.2; P = 0.010) was reduced in nonsurvivors. The clot rate was not different. Cox proportional-hazard model showed that ACT and platelet function correlated independently with survival (P < 0.05). Kaplan-Meier survival curve analysis suggested that patients with one pathological Sonoclot findings have better outcome (P < 0.05). After ACT and platelet function were introduced, the receiver-operating characteristic area under the curve of model achieved 0.876 (P < 0.05), with a specificity of 82.6% and a sensitivity of 80.5% in prediction of 30-day survival by multivariate analyses. Our data suggest that the Sonoclot can predict mortality in critically ill patients with overt DIC.

The Utility of Platelet and Coagulation Testing of Antithrombotics: Fusing Science with Patient Care

[Table: see text] There is an increasing need for the standardization of platelet function and coagulation testing for the assessment of antithrombotic therapies. Investigators continue to strive to identify ideal laboratory testing and monitoring procedures for acquired and inherited platelet function defects as well as for evaluating patient status when treated with existing or emerging antithrombotics. These therapies are used primarily in the treatment of ischemic complications. In patients receiving antithrombotic therapy, the balance between hemostasis and thrombosis is a challenge as there is an ongoing risk for bleeding when patients are receiving antiplatelet agents or anticoagulants to lessen their risk for secondary thrombotic events. There are several diverse tests for monitoring anticoagulant therapy; however, as new agents are developed, more specific tests will be required to directly assess these agents in relationship to overall coagulation status. Research in the platelet biology field is ongoing to provide point-of-care methodologies for the assessment of platelet reactivity in terms of both bleeding and thrombosis risk. Currently there are no instruments that reliably assess the risk of bleeding. The challenges that routinely faced are the complexity of physiology, the need for standardization of platelet testing methodology, and the necessity for appropriate interpretation of the test results.