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Review
. 2020 Jul 30;20(15):4254.
doi: 10.3390/s20154254.

Point-of-Care Diagnostics in Coagulation Management

Sebastian D Sahli  1 , Julian Rössler  1 , David W Tscholl  1 , Jan-Dirk Studt  2 , Donat R Spahn  1 , Alexander Kaserer  1
Affiliations
Review

Point-of-Care Diagnostics in Coagulation Management

Sebastian D Sahli et al. Sensors (Basel). .

Abstract

This review provides a comprehensive and up-to-date overview of point-of-care (POC) devices most commonly used for coagulation analyses in the acute settings. Fast and reliable assessment of hemostasis is essential for the management of trauma and other bleeding patients. Routine coagulation assays are not designed to visualize the process of clot formation, and their results are obtained only after 30-90 m due to the requirements of sample preparation and the analytical process. POC devices such as viscoelastic coagulation tests, platelet function tests, blood gas analysis and other coagulometers provide new options for the assessment of hemostasis, and are important tools for an individualized, goal-directed, and factor-based substitution therapy. We give a detailed overview of the related tests, their characteristics and clinical implications. This review emphasizes the evident advantages of the speed and predictive power of POC clot measurement in the context of a goal-directed and algorithm-based therapy to improve the patient's outcome. Interpretation of viscoelastic tests is facilitated by a new visualization technology.

Keywords: ROTEM®; coagulation management; hemorrhage; platelet function test; point-of-care systems.

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Conflict of interest statement

S.D.S. and J.R. have no conflict of interest to declare. J.-D.S. received lecture and advisory honoraria from Bayer (Switzerland), Shire/Takeda (Switzerland), Sanofi (Switzerland), and Siemens Healthineers (Switzerland). A.K. received honoraria for lecturing from Bayer AG Switzerland. The University of Zurich and Instrumentation Laboratory Company/Werfen Corporation, Bedford, MA, USA, signed a letter of intent regarding a joint development and licensing agreement to develop a product based on the concept of Visual Clot. Within the framework of this letter of intent and a potential later agreement, D.W.T. and D.R.S. might receive royalties as designated inventors. The University of Zurich and Philips Medizin Systeme Böblingen GmbH, Böblingen, Germany and Konikljike Philips N.V., Amsterdam, The Netherlands signed a joint development and licensing agreement to develop a product based on the concept of Visual Patient. Within the framework of this agreement, D.W.T. might receive royalties as designated inventor. D.W.T. received travel support for consulting Instrumentation Laboratory, Bedford, MA, USA and consults Philips Research/Philips Electronics Nederland B.V., Eindhoven, The Netherlands. Dr. Spahn’s academic department is receiving grant support from the Swiss National Science Foundation, Berne, Switzerland, the Swiss Society of Anesthesiology and Reanimation (SGAR), Berne, Switzerland, the Swiss Foundation for Anesthesia Research, Zurich, Switzerland, Vifor SA, Villars-sur-Glâne, Switzerland. Dr. Spahn is co-chair of the ABC-Trauma Faculty, sponsored by unrestricted educational grants from Novo Nordisk Health Care AG, Zurich, Switzerland, CSL Behring GmbH, Marburg, Germany, LFB Biomédicaments, Courtaboeuf Cedex, France and Octapharma AG, Lachen, Switzerland. Dr. Spahn received honoraria/travel support for consulting or lecturing from: Danube University of Krems, Austria, US Department of Defense, Washington, USA, European Society of Anesthesiology, Brussels, BE, Korean Society for Patient Blood Management, Seoul, Korea, Korean Society of Anesthesiologists, Seoul, Korea, Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, Paris, France, Baxalta Switzerland AG, Volketswil, Switzerland, Bayer AG, Zürich, Switzerland, B. Braun Melsungen AG, Melsungen, Germany, Boehringer Ingelheim GmbH, Basel, Switzerland, Bristol-Myers-Squibb, Rueil-Malmaison Cedex, France and Baar, Switzerland, CSL Behring GmbH, Hattersheim am Main, Germany and Berne, Switzerland, Celgene International II Sàrl, Couvet, Switzerland, Daiichi Sankyo AG, Thalwil, Switzerland, Ethicon Sàrl, Neuchâtel, Switzerland, Haemonetics, Braintree, MA, USA, Instrumentation Laboratory (Werfen), Bedford, MA, USA, LFB Biomédicaments, Courtaboeuf Cedex, France, Merck Sharp & Dohme, Kenilworth, New Jersey, USA, PAION Deutschland GmbH, Aachen, Germany, Pharmacosmos A/S, Holbaek, Denmark, Photonics Healthcare B.V., Utrecht, Netherlands, Pfizer AG, Zürich, Switzerland, Pierre Fabre Pharma, Alschwil, Switzerland, Roche Diagnostics International Ltd., Reinach, Switzerland, Sarstedt AG & Co., Sevelen, Switzerland and Nümbrecht, Germany, Shire Switzerland GmbH, Zug, Switzerland, Tem International GmbH, Munich, Germany, Vifor Pharma, Munich, Germany, Neuilly sur Seine, France and Villars-sur-Glâne, Switzerland, Vifor (International) AG, St. Gallen, Switzerland, Zuellig Pharma Holdings, Singapore, Singapore.

Figures

Figure 1
Figure 1
Coagulation cascade and fibrin formation by the intrinsic and extrinsic pathways. The heavy arrows show the extrinsic pathway, triggered by vascular injury and the expression of tissue factor. On the left side, by light arrows, the intrinsic pathway is shown. In the common pathway, thrombin is generated, which converts fibrinogen to fibrin (heavy arrows, too). Reprinted with permission from [13]. Copyright© 1991 American Chemical Society, Washington, DC, USA.
Figure 2
Figure 2
Picture of the ROTEM® temogram displaying the four channels EXTEM, INTEM, FIBTEM and APTEM. Reprinted with the kind permission from the Instrumentation Laboratory, Bedford, MA, USA.
Figure 3
Figure 3
Picture of ROTEM® temogram illustrating the parameters characterizing clot formation. Reprinted with the kind permission from the Instrumentation Laboratory, Bedford, MA, USA.
Figure 4
Figure 4
Coagulation factor deficiency: left, displayed by a four channel ROTEM® report (EXTEM, INTEM, FIBTEM and APTEM); right, by Visual Clot visualization technology.
Figure 5
Figure 5
Low fibrinogen level: left, displayed by a four channel ROTEM® report (EXTEM, INTEM, FIBTEM and APTEM); right, by Visual Clot visualization technology.
Figure 6
Figure 6
Illustration of Multiplate® tests. The ADPtest detects platelets after stimulation of adenosine diphosphate (ADP) receptor pathway P2Y12. The TRAPtest detects platelets after stimulation with the agonist thrombin receptor activating peptide (TRAP) of the protease activated receptor-1 pathway (PAR-1). The RISTOtest detects platelets after stimulation with the agonist ristocetin of the glycoprotein Ib-IX-V (GPIb-IX-V) receptor pathway. The ASPItest detects platelets activated by arachidonic acid (AA). AA is finally converted to thromboxane A2 (TXA2) by cyclooxygenase-1 (COX-1) and others. The COLtest detects platelets activated by AA, too. Collagen is added to the sample and stimulates the collagen receptor glycoprotein VI (GPVI) pathways. No direct Glycoprotein IIb-IIIa (GPIIb-IIIa) receptor measuring.
See this image and copyright information in PMC

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