Rapid bedside coagulometry prior to urgent neurosurgical procedures in anticoagulated patients
- 9 December 2013
- journal article
- Published by Informa UK Limited in British Journal Of Neurosurgery
- Vol. 28 (1), 29-33
- https://doi.org/10.3109/02688697.2013.869549
Abstract
Introduction. With the increased use of oral anticoagulation with vitamin K antagonists, emergency physicians encounter a growing number of patients requiring a rapid reversal of anticoagulant effects in order to perform urgent surgical procedures. Initiation of these procedures can be delayed because the coagulation status has to be assessed through examination of blood samples in central laboratories (CL). This delay may lead to negative effects, especially in potentially life-threatening conditions such as intracranial haemorrhage. Point-of-care (POC) devices for assessment of international normalized ratio (POC INR) have improved the management of anticoagulation therapy in the outpatient setting. The use of these devices may also have beneficial effects in the treatment of anticoagulated patients requiring urgent neurosurgical procedures. The primary aim of this study was to analyse the potential of POC-guided assessment of INR to reduce time to potentially life-saving neurosurgery in this setting. Feasibility and accuracy as well as the gain of time through the use of this device were analysed. Materials and methods. The POC coagulometer CoaguChek XS® was used in 17 patients with a history of anticoagulant use and a condition requiring urgent anticoagulant reversal prior to neurosurgical procedures (burr-hole trepanation: n = 8, craniotomy: n = 7, laminectomy: n = 2). Results. No technical difficulties occurred and rapid assessment of INR was achieved in all cases within 2 min. POC INR values correlated well with CL INR assessment with a mean INR deviation of 0.036 ± 0.12. The mean gain of time through the use of the POC INR device compared with CL assessment of INR was 47 ± 6 min (range: 37–61 min). Conclusion. Our initial experiences with a POC INR device in anticoagulated patients undergoing urgent neurosurgical procedures demonstrate that its use may contribute to an improved management of these patients.Keywords
This publication has 25 references indexed in Scilit:
- Impact of a Pharmacist-Led Warfarin Self-Management Program on Quality of Life and Anticoagulation Control: A Randomized TrialPharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 2012
- National Trends in Oral Anticoagulant Use in the United States, 2007 to 2011Circulation: Cardiovascular Quality and Outcomes, 2012
- Warfarin-Associated Intracerebral Hemorrhage Is Inadequately Treated at Community Emergency DepartmentsStroke, 2012
- Interpretation of Point-of-care INR Results in Patients Treated with DabigatranAmerican Journal Of Medicine, 2012
- Bridging therapy and oral anticoagulation: current and future prospectsCurrent Opinion in Hematology, 2010
- Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)European Heart Journal, 2010
- Point-of-care versus central laboratory coagulation testing during haemorrhagic surgeryThrombosis and Haemostasis, 2009
- Progression of Traumatic Intracerebral Hemorrhage: A Prospective Observational StudyJournal of Neurotrauma, 2008
- Accuracy and clinical utility of the CoaguChek XS portable international normalised ratio monitor in a pilot study of warfarin home-monitoringJournal of Clinical Pathology, 2006
- STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENTThe Lancet, 1986