Advantages of point-of-care methods in perioperative bleeding control

Perioperative bleeding management is a complex task which has significant impact on surgery outcome. Most hemostasis disorders occurring intraoperatively are acute, caused by massive bleeding, and can be explained by the principle of loss, compensation, and dilution of circulating blood volume. Disorders at the level of the hemostatic system can be assessed both by various standard laboratory tests, such as: prothrombin time, activated partial thromboplastin time, platelet count, coagulation factor concentrates, levels of antithrombin and D-dimer; or by point-of-care (POC) methods. Standard laboratory tests have their limitations. They do not detect increased intraoperative bleeding tendency, and it is recommended to use methods such as POC, which quickly and accurately assess the patient’s coagulation status, thus enabling the administration of the appropriate therapy, as soon as possible. The most commonly used POC methods are the aggregometry methods (Multiplate, PFA-100, and Platelet Mapping Assay), used in perioperative platelet function evaluation, and viscoelastic tests (rotational thromboelastometry – ROTEM; thromboelastography – TEG), which provide a graphic representation of all hemostatic activity by measuring the time elapsed until the onset of clot formation, formation dynamics, as well as clot firmness and stability over time. The main advantages of the POC method are: the swift availability of results (up to 15 minutes) and the very small blood sample size (up to 5 ml) necessary for performing the test; while the main disadvantages are: their cost, which exceeds the cost of performing standard laboratory tests, and their inability to detect coagulopathies, resulting from the disturbance of the patient’s normal physiological state. POC methods are very important in reducing perioperative bleeding, reducing blood transfusions, and forming adequate therapeutic algorithms.