Bedside Point of Care Coagulation Testing for Individualized Antivitamin K Reversal: A Prospective Study

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Abstract

A delay in surgery due to laboratory abnormalities may increase mortality in patients with hip fracture. In order to optimize the logistics for urgent surgery in patients with hip fractures and anti-vitamin K treatment, individualized doses of a Prothrombin Concentrate were guided by a bedside whole blood prothrombin time test.

Thirty patients with emergency hip fracture and preoperative anti-vitamin K treatment (warfarin) due to atrial fibrillation were studied during a 3 years period (2010-2012). Intravenous vitamin K was recommended as early as possible after admission at the hospital and after diagnosis of the hip fracture by X-ray, but was not controlled by the authors. Preoperatively the patients were treated with repeated doses of 500 units (U) prothrombin complex factor concentrate (PCC) if laboratory Prothrombin Time International ratio (PT-INR) >1.5 and orthopedic surgents urged for immediate surgery. Simultaneosly whole blood PT-INR and activated prothrombin partial thromboplastin time (aPTT) was checked with a bedside point-of-care HEMOCHRON Jr with blood from the citrated vacutainer test tubes, before these were sent to the laboratory. Both types of PT were checked 10 minutes after the intravenous PCC injection.

The correlation coefficient between routine citrated plasma PT and the whole blood citrated HEMOCHRON® PT was 0,88 (p>0,001). All patients underwent surgery within 24 hours. No plasma was used. Vitamin K was used in 20 of the patients and reduced the need/doses of PCC as compared to patients with no vitamin K treatment. Five mg of iv vitamin K was more effective than 2 mg iv in reducing the need for PCC.

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  • Anesthesiology and Intensive Care
Original languageEnglish
Pages (from-to)8-12
JournalJournal of Cardiovascular disease
Volume1
Issue number1
Publication statusPublished - 2013
Publication categoryResearch
Peer-reviewedYes

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Ulf Schött

1990/05/012019/03/31

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