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LaboratoriumsMedizin
Article . 2002 . Peer-reviewed
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LaboratoriumsMedizin
Article . 2002 . Peer-reviewed
License: Wiley TDM
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Point-of-Care Analyse des Hamostasesystems. Point-of-Care Analysis of the Hemostatic System

Authors: Michael Spannagl; Andreas Calatzis;

Point-of-Care Analyse des Hamostasesystems. Point-of-Care Analysis of the Hemostatic System

Abstract

Zusammenfassung: Eine Reihe von hamostaseologischen Point of Care (POC)-Verfahren hat vor allem in den letzten Jahren ihren Einsatz in der Klinik und im Selbstmanagement des Patienten gefunden. Das Spektrum der verfugbaren Methoden erstreckt sich von einfachen Instrumenten zur Erfassung der plasmatischen Gerinnung (ACT, CoaguCheck, Rapidpoint Coag), uber Thrombozytenfunktionstests (PFA-100, RPFA) bis hin zu den komplexeren viskoelastischen Analyseverfahren (TEG, ROTEG, Sonoclot). Der entscheidende Vorteil der POC-Analyse ist die schnelle Verfugbarkeit der Ergebnisse mit der Moglichkeit der zielgerichteten therapeutischen Intervention. Nutzen und Risiken der POC-Verfahren werden entscheidend von der Dringlichkeit der Analyse, der Response-Zeit des Labors, den verfugbaren personellen und logistischen Ressourcen sowie von dem zu erwartenden Spektrum der Gerinnungsveranderungen gepragt. Bei der Steuerung der Antikoagulation mittels Heparin oder Hirudin ist die POC-Analyse haufig sinnvoll und hat sich hier entsprechend weit durchgesetzt. Die Steuerung des Hamostasemanagements bei akuten Blutungen, sowie operativen Eingriffen mit hohem Transfusionsbedarf mittels der POC-Analytik ist vor allem im angloamerikanischen Raum weit verbreitet. Ein haufig vernachlassigter Aspekt bei der POC-Analyse ist die Qualitatssicherung. Da Vollblut nicht uber langere Zeit stabil ist und auch nicht lyophilierbar ist, werden Kontrollmaterialien auf der Basis von Plasma, artifizielle Flussigkeiten sowie elektronische und on-board Verfahren eingesetzt. Die Einfuhrung und der Betrieb von POC-Methoden stellt die klinisch tatigen Kollegen vor neue Herausforderungen, wobei die schnelle Diagnostik mit der Moglichkeit der zielgerichteten Therapie den Einsatz dieser Methoden sinnvoll und kosteneffektiv gestalten kann. Summary: Several Point-of-Care (POC) methods for the analysis of the hemostatic system have been introduced into clinical applications during the last years. Available methods include simple instruments for the assessment of plasmatic coagulation (ACT, CoaguCheck, Rapidpoint Coag), specific platelet function assays (PFA-100, RPFA), and the more complex visco-elastic assays (TEG, ROTEG, Sonoclot). The main advantage of POC analysis is the short turn-around time which allows a targeted hemostasis management. The benefit and the risks of POC analysis depend on the urgency of the analysis, the turn-around time of the laboratory analysis, the availability of motivated staff at the point of care and the expected hemostatic alterations. The use of POC analysis for the monitoring of heparin and hirudin is often justified and is widely applied. The monitoring-directed management of acute bleeding complications using POC analysis is in particular popular in the english-speaking countries, while it is less frequently applied in central Europe. An underestimated aspect of POC analysis is the importance of established quality management procedures. As whole blood is not stable for longer periods and cannot be lyophilizied without large alterations, control materials based on plasma, artificial fluids, and electronic on-board methods are applied. In conclusion the introduction and the application of POC methods provides new tasks and challenges. The fast analysis of the hemostasic system and the ability for targeted therapeutic approaches can make this approach useful and economically effective.

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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
3
Average
Average
Average
hybrid