Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence?
Identifieur interne : 000237 ( Main/Exploration ); précédent : 000236; suivant : 000238Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence?
Auteurs : T. Haas [Suisse] ; D. Fries [Autriche] ; K A Tanaka [États-Unis] ; L. Asmis [Suisse] ; N S Curry [Royaume-Uni] ; H. Schöchl [Autriche]Source :
- British journal of anaesthesia [ 1471-6771 ] ; 2015.
Descripteurs français
- KwdFr :
- Complications peropératoires (), Complications peropératoires (diagnostic), Complications postopératoires (), Complications postopératoires (diagnostic), Humains, Hémorragie (), Hémorragie (diagnostic), Médecine factuelle, Soins périopératoires (), Tests de coagulation sanguine, Troubles de l'hémostase et de la coagulation (), Troubles de l'hémostase et de la coagulation (diagnostic).
- MESH :
- diagnostic : Complications peropératoires, Complications postopératoires, Hémorragie, Troubles de l'hémostase et de la coagulation.
- Complications peropératoires, Complications postopératoires, Humains, Hémorragie, Médecine factuelle, Soins périopératoires, Tests de coagulation sanguine, Troubles de l'hémostase et de la coagulation.
English descriptors
- KwdEn :
- Blood Coagulation Disorders (diagnosis), Blood Coagulation Disorders (therapy), Blood Coagulation Tests, Evidence-Based Medicine, Hemorrhage (diagnosis), Hemorrhage (therapy), Humans, Intraoperative Complications (diagnosis), Intraoperative Complications (therapy), Perioperative Care (methods), Postoperative Complications (diagnosis), Postoperative Complications (therapy).
- MESH :
- diagnosis : Blood Coagulation Disorders, Hemorrhage, Intraoperative Complications, Postoperative Complications.
- methods : Perioperative Care.
- therapy : Blood Coagulation Disorders, Hemorrhage, Intraoperative Complications, Postoperative Complications.
- Blood Coagulation Tests, Evidence-Based Medicine, Humans.
Abstract
Standard laboratory coagulation tests (SLTs) such as prothrombin time/international normalized ratio or partial thromboplastin time are frequently used to assess coagulopathy and to guide haemostatic interventions. However, this has been challenged by numerous reports, including the current European guidelines for perioperative bleeding management, which question the utility and reliability of SLTs in this setting. Furthermore, the arbitrary definition of coagulopathy (i.e. SLTs are prolonged by more than 1.5-fold) has been questioned. The present study aims to review the evidence for the usefulness of SLTs to assess coagulopathy and to guide bleeding management in the perioperative and massive bleeding setting. Medline was searched for investigations using results of SLTs as a means to determine coagulopathy or to guide bleeding management, and the outcomes (i.e. blood loss, transfusion requirements, mortality) were reported. A total of 11 guidelines for management of massive bleeding or perioperative bleeding and 64 studies investigating the usefulness of SLTs in this setting were identified and were included for final data synthesis. Referenced evidence for the usefulness of SLTs was found in only three prospective trials, investigating a total of 108 patients (whereby microvascular bleeding was a rare finding). Furthermore, no data from randomized controlled trials support the use of SLTs. In contrast, numerous investigations have challenged the reliability of SLTs to assess coagulopathy or guide bleeding management. There is actually no sound evidence from well-designed studies that confirm the usefulness of SLTs for diagnosis of coagulopathy or to guide haemostatic therapy.
DOI: 10.1093/bja/aeu303
PubMed: 25204698
Affiliations:
- Autriche, Royaume-Uni, Suisse, États-Unis
- Angleterre, Oxfordshire, Pennsylvanie, Vienne (Autriche)
- Oxford, Vienne (Autriche)
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Le document en format XML
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Haas</name><affiliation wicri:level="1"><nlm:affiliation>Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland thorsten.haas@kispi.uzh.ch.</nlm:affiliation><country wicri:rule="url">Suisse</country><wicri:regionArea>Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich</wicri:regionArea><wicri:noRegion>8032 Zurich</wicri:noRegion></affiliation></author><author><name sortKey="Fries, D" sort="Fries, D" uniqKey="Fries D" first="D" last="Fries">D. 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However, this has been challenged by numerous reports, including the current European guidelines for perioperative bleeding management, which question the utility and reliability of SLTs in this setting. Furthermore, the arbitrary definition of coagulopathy (i.e. SLTs are prolonged by more than 1.5-fold) has been questioned. The present study aims to review the evidence for the usefulness of SLTs to assess coagulopathy and to guide bleeding management in the perioperative and massive bleeding setting. Medline was searched for investigations using results of SLTs as a means to determine coagulopathy or to guide bleeding management, and the outcomes (i.e. blood loss, transfusion requirements, mortality) were reported. A total of 11 guidelines for management of massive bleeding or perioperative bleeding and 64 studies investigating the usefulness of SLTs in this setting were identified and were included for final data synthesis. Referenced evidence for the usefulness of SLTs was found in only three prospective trials, investigating a total of 108 patients (whereby microvascular bleeding was a rare finding). Furthermore, no data from randomized controlled trials support the use of SLTs. In contrast, numerous investigations have challenged the reliability of SLTs to assess coagulopathy or guide bleeding management. There is actually no sound evidence from well-designed studies that confirm the usefulness of SLTs for diagnosis of coagulopathy or to guide haemostatic therapy.</div></front></TEI><affiliations><list><country><li>Autriche</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Oxfordshire</li><li>Pennsylvanie</li><li>Vienne (Autriche)</li></region><settlement><li>Oxford</li><li>Vienne (Autriche)</li></settlement></list><tree><country name="Suisse"><noRegion><name sortKey="Haas, T" sort="Haas, T" uniqKey="Haas T" first="T" last="Haas">T. 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