Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients.

The study presented by Weber and coworkers is the first prospective, randomized and controlled clinical trial investigating the efficacy and the efficiency of a point-of-care (POC) test-guided, differentiated hemostatic treatment in 100 coagulopathic cardiac surgical patients. Coagulopathy was defined as diffuse bleeding after reversal of heparin or increased blood loss in the first 24 hours after surgery. Compared were 1) an algorithm-based hemostatic management (n = 50 patients) guided by thrombelastography (monitoring plasmatic coagulation by viscoelastic analysis of clot-formation and dissolution) and aggregometry (monitoring platelet function) with 2) a hemostatic management based on conventional laboratory tests (n = 50 patients) i.e. platelet count, fibrinogen concentration, international normalized ratio of the PT and activated partial thromboplastin time. The red blood cell transfusion rate (98% vs. 84%, POC vs. conventional treatment, P < 0.05), the number of RBC units transfused (median 5 vs. 3 units, POC vs. conventional treatment, P < 0.05) as well as the costs related to the hemostatic management (1658 € vs. 3109 €, POC vs. conventional treatment) were lower in the POC-guided treatment group. In addition to these very interesting findings the manuscript nicely summarizes the modern principles of differentiated coagulation therapy and provides excellent algorithms to guide clinicians through the complex POC-guided coagulation management.

– Oliver Habler