Correlation of activated clotting times and standard laboratory coagulation tests in paediatric non-cardiac surgery

The activated clotting time (ACT) was invented as a whole blood test to detect coagulopathy, but nowadays is almost exclusively used to guide heparin anticoagulation. Although the ACT provides a fairly reliable and fast bedside test of the coagulation status, only a few studies have focused on its use to monitor pre- or intraoperative coagulation status as an early marker of impaired haemostasis or increased bleeding tendency. The aim of this study was to compare intraoperative i-STAT(®) ACT values with commonly used thresholds of standard coagulation tests for the diagnosis of coagulopathy during paediatric non-cardiac surgery. We performed a prospective, observational study in a University Children's hospital and included 50 paediatric patients who underwent major elective, non-cardiac, surgery. The i-STAT(®) kaolin ACT test was obtained intraoperatively and compared to the commonly used threshold of standard coagulation tests (PT/INR, aPTT, and plasma fibrinogen level). A total of 181 blood samples were taken from 50 pediatric patients. Moderate correlation was found between ACT and aPTT (r = 0.694; p < 0.001), and all other coagulation tests. The median ACT values remained within the normal range throughout the entire surgical phase, while standard coagulation tests were mostly abnormal during surgery. Intraoperative measurement of ACT did not provide comparable thresholds of normal haemostasis as compared to standard coagulation testing

Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia

BACKGROUND: Patients with severe thrombocytopenia are at risk for bleeding during insertion of central venous catheters (CVCs). Although most guidelines recommend preprocedural platelet (PLT) transfusions at a threshold of less than 50 × 10(9) /L, there is only weak evidence supporting such recommendations. STUDY DESIGN AND METHODS: The current study aimed to establish a safe PLT transfusion trigger in patients with CVC placements. We performed a retrospective single-center analysis of 604 CVC insertions in 193 patients with acute leukemia receiving intensive chemotherapy or stem cell transplantation. RESULTS: A total of 48% of the patients had a bleeding risk during CVC insertions, mostly due to thrombocytopenia. The bleeding incidence was 32% with 96% Grade 1 and 4% Grade 2 bleedings requiring prolonged local compression. There were no Grade 3 to 4 bleedings. Hemoglobin levels were similar before and 24 and 48 hours after the CVC insertion in the bleeding and nonbleeding group and there was no difference in the red blood cell (p = 0.72) and PLT transfusion requirements (p = 0.057) after CVC insertion. In multivariate analysis, only patients with PLT counts of less than 20 × 10(9) /L were at higher risk for bleeding before (p = 0.015) and after preprocedural PLT transfusions (p = 0.006) compared to patients with PLT counts of 100 × 10(9) /L or more. CONCLUSION: CVC placements can safely be performed in patients with PLT counts of 20 × 10(9) /L or more without preprocedural PLT transfusions

Guidelines for the use of platelet transfusions.

Accepted manuscript, 12 month embargo