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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Tate, Jillian R. / Tsongalis, Gregory J.

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IMPACT FACTOR 2014: 2.707
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Preoperative Values of Molecular Coagulation Markers Identify Patients at Low Risk for Intraoperative Haemostatic Disorders and Excessive Blood Loss

Wolfgang Korte / Berta Truttmann / Christoph Heim / Ulrike Stangl / Luzius Schmid / Georg Kreienbühl

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 36, Issue 4, Pages 235–240, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.1998.040, June 2005

Publication History

Published Online:
2005-06-01

Abstract

Conventional laboratory investigations of haemostasis like prothrombin time and activated partial thromboplastin time are not useful in predicting and managing intra-operative bleeding complications. In order to establish a possible “perioperative reference range” for thrombin generation prothrombin fragment F1+2 (F1+2) and fibrin degradation (D-dimer) markers, we measured F1+2 and D-dimer concentrations before surgery (but after induction of anaesthesia), 30 minutes into surgery, 10 minutes after the event expected to induce the maximal activation of the haemostatic systems, 90 minutes after surgery and on postoperative days 1 and 2 in 226 consecutive patients. Samples were collected from arterial lines. Twenty patients developed a clinically defined, intraoperative disorder of haemostasis, 206 did not. Patients with an intraoperative disorder of haemostasis had significantly higher preoperative F1+2 and D-dimer concentrations. Preoperative values for F1+2 and D-dimer concentrations above the 75th percentile of patients without an intraoperative disorder of haemostasis indicated a 2.70 to 2.88 fold risk of developing an intraoperative disorder of haemostasis (odds ratios were 3.04, 3.12 and 3.29 for D-dimer, ELISA, F1+2, and D-dimer latex tests, respectively with 95% confidence intervals from 1.20 to 8.46) with negative predictive values of 94%, but positive predictive values of only 16% to 26%. These data suggest that preoperative determination of molecular markers might be helpful in identifying a group of patients at high risk for intraoperative disorder of haemostasis by exclusion of low risk patients. Validation of such an approach requires a prospective trial.

Citing Articles

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[1]
Herney Andrés García, Carlos Gonzalo Estrada, and Jorge Carbonell
Actas Urológicas Españolas, 2009, Volume 33, Number 8, Page 860
[2]
C Bléry
Annales Françaises d'Anesthésie et de Réanimation, 2001, Volume 20, Number 8, Page 669
[3]
Vladimir Radulovic, Monica Hyllner, Lisa Ternström, Martin Karlsson, Anders Bylock, Kenny M. Hansson, Fariba Baghaei, and Anders Jeppsson
Thrombosis Research, 2012, Volume 130, Number 5, Page 769
[4]
Wolfgang Korte
Best Practice & Research Clinical Anaesthesiology, 2010, Volume 24, Number 1, Page 85
[5]
J. Boldt, I. Huttner, S. Suttner, B. Kumle, S. N. Piper, and G. Berchthold
British Journal of Anaesthesia, 2001, Volume 87, Number 3, Page 435
[6]
Ralf U. Scherer and Sven Pulletz
Current Opinion in Anaesthesiology, 1999, Volume 12, Number 3, Page 349
[7]
Wolfgang Korte, MD, Susan Clarke, MT(ASCP), and Jerry B. Lefkowitz, MD
American Journal of Clinical Pathology, 2000, Volume 113, Number 1, Page 123
[8]
Scott T. Tagawa, Tanya B. Dorff, Leanne Rochanda, Wei Ye, Soames Boyle, Derek Raghavan, Gary Lieskovsky, Donald G. Skinner, David I. Quinn, and Howard A. Liebman
BJU International, 2008, Volume 102, Number 9, Page 1086
[9]
Jochen D. Muehlschlegel and Simon C. Body
American Journal of Hematology, 2008, Volume 83, Number 9, Page 732
[10]
Anesthesiology, 2002, Volume 96, Number 2, Page 485
[11]
Patrick Wettstein, Andr?? Haeberli, Monika Stutz, Miriam Rohner, Cinzia Corbetta, Konrad Gabi, Thomas Schnider, and Wolfgang Korte
Anesthesia & Analgesia, 2004, Page 1564

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