Utility of whole blood hemostatometry using The Clot Signature Analyzer® for assessment of hemostasis in cardiac surgery

Nauder Faraday, Eliseo Guallar, Valerie Sera, Everlie D. Bolton, Robert B. Scharpf, Ann M. Cartarius, Kathryn Emery, Julia Concord, Thomas S. Kickler

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: A hemostatic monitor capable of rapid, accurate detection of clinical coagulopathy within the operating room could improve management of bleeding after cardiopulmonary bypass (CPB). The Clot Signature Analyzer® is a hemostatometer that measures global hemostasis in whole blood. The authors hypothesized that point-of-care hemostatometry could detect a clinical coagulopathic state in cardiac surgical patients. Methods: Fifty-seven adult patients scheduled for a variety of elective cardiac surgical procedures were studied. Anesthesia, CPB, heparin anticoagulation, protamine reversal, and transfusion for post-CPB bleeding were all managed by standardized protocol. Clinical coagulopathy was defined by the need for platelet or fresh frozen plasma transfusion. The Clot Signature Analyzer® collagen-induced thrombus formation (CITF) assay measured platelet-mediated hemostasis in vitro. The activated clotting time, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen concentration were also measured. Results: The postprotamine CITF was greater in patients who required hemostatic transfusion than in those who did not (17.6 ± 8.0 min vs. 10.5 ± 5.7 min, respectively; P <0.01). Postprotamine CITF values were highly correlated with platelet and fresh frozen plasma transfusion (Spearman r = 0.50, P <0.001 and r = 0.40, P <0.005, respectively). Receiver operator characteristic curves showed a highly significant relation between the postprotamine CITF and intraoperative platelet and fresh frozen plasma transfusion (area under the curve, 0.78- 0.81, P <0.005) with 60-80% sensitivity, specificity, positive and negative predictive values at cutoffs of 12-14 min. Logistic regression demonstrated that the CITF was independently predictive of post-CPB hemostatic transfusion, but standard hemostatic assays were not. Conclusions: The Clot Signature Analyzer® CITF detects a clinical coagulopathic state after CPB and is independently predictive of the need for hemostatic transfusion. Hemostatometry has potential utility for monitoring hemostasis in cardiac surgery.

Original languageEnglish (US)
Pages (from-to)1115-1122
Number of pages8
JournalAnesthesiology
Volume96
Issue number5
DOIs
StatePublished - 2002
Externally publishedYes

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Hemostasis
Thoracic Surgery
Hemostatics
Cardiopulmonary Bypass
Thrombosis
Collagen
Blood Platelets
Elective Surgical Procedures
Point-of-Care Systems
Cardiac Surgical Procedures
Hemorrhage
Protamines
Partial Thromboplastin Time
Prothrombin Time
Operating Rooms
Platelet Count
Fibrinogen
Area Under Curve
Heparin
Anesthesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Utility of whole blood hemostatometry using The Clot Signature Analyzer® for assessment of hemostasis in cardiac surgery. / Faraday, Nauder; Guallar, Eliseo; Sera, Valerie; Bolton, Everlie D.; Scharpf, Robert B.; Cartarius, Ann M.; Emery, Kathryn; Concord, Julia; Kickler, Thomas S.

In: Anesthesiology, Vol. 96, No. 5, 2002, p. 1115-1122.

Research output: Contribution to journalArticle

Faraday, N, Guallar, E, Sera, V, Bolton, ED, Scharpf, RB, Cartarius, AM, Emery, K, Concord, J & Kickler, TS 2002, 'Utility of whole blood hemostatometry using The Clot Signature Analyzer® for assessment of hemostasis in cardiac surgery', Anesthesiology, vol. 96, no. 5, pp. 1115-1122. https://doi.org/10.1097/00000542-200205000-00014
Faraday, Nauder ; Guallar, Eliseo ; Sera, Valerie ; Bolton, Everlie D. ; Scharpf, Robert B. ; Cartarius, Ann M. ; Emery, Kathryn ; Concord, Julia ; Kickler, Thomas S. / Utility of whole blood hemostatometry using The Clot Signature Analyzer® for assessment of hemostasis in cardiac surgery. In: Anesthesiology. 2002 ; Vol. 96, No. 5. pp. 1115-1122.
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abstract = "Background: A hemostatic monitor capable of rapid, accurate detection of clinical coagulopathy within the operating room could improve management of bleeding after cardiopulmonary bypass (CPB). The Clot Signature Analyzer{\circledR} is a hemostatometer that measures global hemostasis in whole blood. The authors hypothesized that point-of-care hemostatometry could detect a clinical coagulopathic state in cardiac surgical patients. Methods: Fifty-seven adult patients scheduled for a variety of elective cardiac surgical procedures were studied. Anesthesia, CPB, heparin anticoagulation, protamine reversal, and transfusion for post-CPB bleeding were all managed by standardized protocol. Clinical coagulopathy was defined by the need for platelet or fresh frozen plasma transfusion. The Clot Signature Analyzer{\circledR} collagen-induced thrombus formation (CITF) assay measured platelet-mediated hemostasis in vitro. The activated clotting time, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen concentration were also measured. Results: The postprotamine CITF was greater in patients who required hemostatic transfusion than in those who did not (17.6 ± 8.0 min vs. 10.5 ± 5.7 min, respectively; P <0.01). Postprotamine CITF values were highly correlated with platelet and fresh frozen plasma transfusion (Spearman r = 0.50, P <0.001 and r = 0.40, P <0.005, respectively). Receiver operator characteristic curves showed a highly significant relation between the postprotamine CITF and intraoperative platelet and fresh frozen plasma transfusion (area under the curve, 0.78- 0.81, P <0.005) with 60-80{\%} sensitivity, specificity, positive and negative predictive values at cutoffs of 12-14 min. Logistic regression demonstrated that the CITF was independently predictive of post-CPB hemostatic transfusion, but standard hemostatic assays were not. Conclusions: The Clot Signature Analyzer{\circledR} CITF detects a clinical coagulopathic state after CPB and is independently predictive of the need for hemostatic transfusion. Hemostatometry has potential utility for monitoring hemostasis in cardiac surgery.",
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AU - Faraday, Nauder

AU - Guallar, Eliseo

AU - Sera, Valerie

AU - Bolton, Everlie D.

AU - Scharpf, Robert B.

AU - Cartarius, Ann M.

AU - Emery, Kathryn

AU - Concord, Julia

AU - Kickler, Thomas S.

PY - 2002

Y1 - 2002

N2 - Background: A hemostatic monitor capable of rapid, accurate detection of clinical coagulopathy within the operating room could improve management of bleeding after cardiopulmonary bypass (CPB). The Clot Signature Analyzer® is a hemostatometer that measures global hemostasis in whole blood. The authors hypothesized that point-of-care hemostatometry could detect a clinical coagulopathic state in cardiac surgical patients. Methods: Fifty-seven adult patients scheduled for a variety of elective cardiac surgical procedures were studied. Anesthesia, CPB, heparin anticoagulation, protamine reversal, and transfusion for post-CPB bleeding were all managed by standardized protocol. Clinical coagulopathy was defined by the need for platelet or fresh frozen plasma transfusion. The Clot Signature Analyzer® collagen-induced thrombus formation (CITF) assay measured platelet-mediated hemostasis in vitro. The activated clotting time, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen concentration were also measured. Results: The postprotamine CITF was greater in patients who required hemostatic transfusion than in those who did not (17.6 ± 8.0 min vs. 10.5 ± 5.7 min, respectively; P <0.01). Postprotamine CITF values were highly correlated with platelet and fresh frozen plasma transfusion (Spearman r = 0.50, P <0.001 and r = 0.40, P <0.005, respectively). Receiver operator characteristic curves showed a highly significant relation between the postprotamine CITF and intraoperative platelet and fresh frozen plasma transfusion (area under the curve, 0.78- 0.81, P <0.005) with 60-80% sensitivity, specificity, positive and negative predictive values at cutoffs of 12-14 min. Logistic regression demonstrated that the CITF was independently predictive of post-CPB hemostatic transfusion, but standard hemostatic assays were not. Conclusions: The Clot Signature Analyzer® CITF detects a clinical coagulopathic state after CPB and is independently predictive of the need for hemostatic transfusion. Hemostatometry has potential utility for monitoring hemostasis in cardiac surgery.

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