Jun 27 • General discussion
Intraoperative tests for coagulopathy
Key tests include point-of-care tests like thromboelastography (TEG) or rotational thromboelastometry (ROTEM), and standard laboratory tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and platelet count.
Point-of-Care Tests:
- Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM):These tests analyze the viscoelastic properties of blood clot formation, providing a comprehensive assessment of coagulation. They can detect abnormalities in clot formation, stability, and lysis.
- Activated Clotting Time (ACT):This test offers a rapid assessment of clotting time, useful during procedures like cardiac surgery where anticoagulation is often reversed.
Standard Laboratory Tests:
- Prothrombin Time (PT) and International Normalized Ratio (INR):These tests assess the extrinsic and common pathways of coagulation, often used to monitor the effects of warfarin.
- Activated Partial Thromboplastin Time (aPTT):This test evaluates the intrinsic and common pathways of coagulation, useful in monitoring heparin therapy.
- Platelet Count:A low platelet count can indicate thrombocytopenia, a condition associated with impaired clotting.
- Fibrinogen Level:Fibrinogen is a crucial protein for clot formation, and low levels can impair clotting.
- Thrombin Time (TT):This test assesses the final step of clot formation, where thrombin converts fibrinogen to fibrin.
Other Considerations:
- Visual Assessment:Surgeons' visual assessment of bleeding during surgery is also an important aspect of decision-making, but it is subjective and relies on experience.
- Laboratory-guided Coagulation Therapy:The results of these tests guide the administration of blood products like fresh frozen plasma, platelets, and cryoprecipitate to correct coagulation defects.
- Individualized Approach:The choice of tests and treatment strategies should be tailored to the specific patient and surgical procedure.
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Intraoperative tests for coagulopathy
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