Abstract
Purpose
The objective of the study was to compare a bedside whole blood activated partial thromboplastin time (aPTT) performed by a point of care (POC) apparatus (CoaguCheck® Pro) in surgical intensive care (SIC) patients with a conventional aPTT obtained from the central laboratory.
Methods
The prospective concomitant measurements of the two aPTT were performed in 233 samples from 46 consecutive patients admitted after cardiovascular or major abdominal surgery.
Results
Inter-operator, inter-instrument and inter-cartridge variability of the new device measured in three healthy volunteers and in nine patients in stable condition (controls) was low (F test: P=0.86). The agreement by Bland and Altman between POC and central laboratory aPTT (−20.2 ± 18.8 sec) was not satisfactory. The agreement between POC and central laboratory aPTT in patients after surgery was worst (−17 ±33.1 sec). Heparin treatment or timing of blood sampling after intensive care admission (< 48 hrvs > 48 hr) did not influence the agreement. The correlation between POC or central laboratory aPTT and anti-factor Xa activity was poor (r2 0.077 and 0.181 respectively). The test which correlated the best to heparin doses was anti-factor Xa activity (r2 0.714).
Conclusion
POC aPTT and central laboratory aPTT showed a poor agreement in SIC patients admitted after surgery, although in healthy volunteers or in control patients, this agreement was better. The best test to monitor heparin treatment in this setting was anti-factor Xa activity.
Résumé
Objectif
Comparer le temps de céphaline activé (TCA) du sang total réalisé au chevet du malade (CDM), au moyen d’un CoaguCheck® Pro, avec le TCA traditionnel obtenu d’un laboratoire central, pour des patients aux soins intensifs chirurgicaux (SIC).
Méthode
Les mesures prospectives concomitantes des deux TCA ont été faites pour 233 échantillons prélevés auprès de 46 patients successifs admis aux SIC après une opération cardiovasculaire ou abdominale majeure.
Résultats
La variabilité interopérateurs, interinstruments et interéprouvettes du nouvel appareil étudié auprès de trois volontaires en bonne santé et neuf patients de condition stable (témoins) a été faible (Test F: P = 0,86). Le test de concordance de Bland et Altman entre le TCA (− 20,2 ± 18,8 s) réalisé au CDM ou en laboratoire n’était pas satisfaisant. Ce même test réalisé chez des patients après l’opération a été pire (− 17 ± 33,1 sec). Le traitement à l’héparine ou la chronologie de l’échantillonnage prélevé après l’arrivée aux soins intensifs (< 48 h vs > 48 h) n’a pas eu d’effet sur la concordance. Il n’existait qu’une très faible corrélation entre le TCA fait au CDM ou en laboratoire et l’activité de l’antifacteur Xa (r2 0,077 et 0,181 respectivement). Le test le mieux corrélé aux doses d’héparine a été l’activité de l’antifacteur Xa (r2 0,714).
Conclusion
Le TCA fait au CDM et le TCA du laboratoire central n’ont affiché qu’une faible concordance chez des patients des SIC admis après l’intervention, même si cette concordance a été meilleure pour des patients témoins et des volontaires en bonne santé. Dans ces circonstances, le meilleur test pour suivre le traitement avec héparine a été l’activité de l’antifacteur Xa.
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Ferring, M., Reber, G., de Moerloose, P. et al. Point of care and central laboratory determinations of the aPTT are not interchangeable in surgical intensive care patients. Can J Anesth 48, 1155–1160 (2001). https://doi.org/10.1007/BF03020384
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DOI: https://doi.org/10.1007/BF03020384