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首页> 外文期刊>British journal of neurosurgery >Rapid bedside coagulometry prior to urgent neurosurgical procedures in anticoagulated patients
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Rapid bedside coagulometry prior to urgent neurosurgical procedures in anticoagulated patients

机译：抗凝患者在紧急神经外科手术前快速床旁凝血测定

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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.
机译：介绍。随着口服抗凝剂与维生素K拮抗剂的使用增加，急诊医师遇到了越来越多的需要快速逆转抗凝作用才能执行紧急外科手术的患者。这些程序的启动可能会延迟，因为必须通过在中央实验室（CL）中检查血液样本来评估凝血状态。这种延迟可能导致负面影响，尤其是在可能危及生命的情况下，例如颅内出血。用于评估国际标准化比率（POC INR）的即时医疗（POC）设备改善了门诊患者抗凝治疗的管理。在需要紧急神经外科手术的抗凝患者的治疗中，这些设备的使用也可能具有有益的效果。这项研究的主要目的是分析POC指导的INR评估在这种情况下减少可能挽救生命的神经外科手术时间的潜力。分析了使用该设备的可行性和准确性以及所获得的时间。材料和方法。 POC凝血仪CoaguChek XS？ 17例有抗凝剂使用史且需要在神经外科手术前紧急逆转抗凝剂的病患（毛孔孔破裂：n = 8，开颅手术：n = 7，椎板切除术：n = 2）。结果。没有发生技术难题，并且在2分钟内所有病例均实现了INR的快速评估。 POC INR值与CL INR评估密切相关，平均INR偏差为0.036±0.12。与使用CL评估INR相比，使用POC INR设备获得的平均时间为47±6分钟（范围：37-61分钟）。结论。我们在接受紧急神经外科手术的抗凝患者中使用POC INR设备的初步经验表明，使用POC INR设备可能有助于改善对这些患者的管理。

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