【体外膜肺ECMO精品课件】 Coagulation Testing.pptVIP

Platelet Inhibitors ReoPro elevates ACTs target time = 250 sec with ReoPro determined using FTCA510 tube Integrelin No reported clinically significant effects on ACT Aggrastat No reported effects on ACT Clinical Applications Operating Room Cardiac Surgery Interventional Cardiology and Radiology Critical Care Satellite Sites Dialysis ECMO Emergency Room Anticoagulation Clinic ACT or aPTT Determine when to pull the femoral sheath Premature sheath pull can lead to bleeding. Delayed removal can increase time in CCU. Target set at each site. ACT targets range from 150 – 220 seconds aPTT targets range from 40 – 70 seconds Must be linked to heparin sensitivity of reagent used ACT vs aPTT Single site comparison, ACT tube vs HE Jr Sig aPTT ACT or aPTT Monitor heparin therapy Target times determined by each facility APTT outcome study Reduce time to result (112 vs 5 minute) Reduce time to stabilization Reduce dose adjustments Reduce length of stay By using POC aPTT instead of lab Poster at AACC 2000 – Staikos, et.al. Activated Partial Thromboplastin Time Intrinsic Pathway Extrinsic Pathway Common Pathway CLOT APTT NOT a PTT PTT is the predecessor of the aPTT Not used anymore Laboratory or Point of Care High APTT values presence of heparin treat by giving protamine underlying coagulopathy treat by giving FFP Monitor heparin / Coumadin? cross-over Activated Partial Thromboplastin Time Heparin versus Warfarin Prothrombin Time Intrinsic Pathway Extrinsic Pathway Common Pathway CLOT PT Prothrombin Time Monitor warfarin therapy Monitor heparin/warfarin crossover Target times are set by International Normalized Ratio (INR) ISI = international Sensitivity Index INR target ranges are specified by patient populations DVT, Afib, Atrial MHV: INR= 2.0 - 3.0 Mitral mechanical heart valve: INR= 2.5 – 3.5 Hypercoagulable disorders: INR= 1.5 – 2.5? Will POC Results Match the Lab? (Probably Not) but it WILL Correlate Correlate Does Not Mean Match Coag is NOT Chemistry Compare for your si