POCT即时检验[整理].pptVIP

Point of Care Coagulation Testing Test Menu ACT - multiple activators Dosing Assays for Open Heart Surgery Heparin and Protamine APTT - fresh or citrated blood PT - fresh or citrated blood Fibrinogen TT - thrombin time * 精品ppt·实用可编辑 Point-Of-Care Coagulation Testing Clinical Applications Operating Room Cardiac Surgery Interventional Cardiology and Radiology Critical Care Satellite Sites Dialysis ECMO Emergency Room Anticoagulation Clinic * 精品ppt·实用可编辑 What do we use an ACT for? Maintain Balance Bleeding Thrombosis Heparin Rapid Anticoagulant Effect Individual sensitivities vary significantly Potency differences Source: Bovine or Porcine Lot to Lot variability Rapidly Reversible with Protamine * 精品ppt·实用可编辑 Why are there so many different ACTs? * 精品ppt·实用可编辑 Monitoring Heparin with ACT Benefits Industry Standard Since 1970 – Hemochron pioneered ACT testing in 1969 Recommended as primary method in AmSECT guidelines (perfusion) Easy to run Inexpensive * 精品ppt·实用可编辑 Monitoring Heparin with ACT Disadvantages Each system yields somewhat different numbers High sensitivity to hypothermia and hemodilution (with exceptions) Little correlation to heparin level in pediatric patients * 精品ppt·实用可编辑 Monitoring during Open Heart Surgery Data from clinical evaluation, on file, ITC * 精品ppt·实用可编辑 Monitoring during Open Heart Surgery Data from clinical evaluation, on file, ITC * 精品ppt·实用可编辑 Pharmaceutical Intervention Amicar or Transexamic Acid No effect on standard celite ACT Continued debate on efficacy Multiple reports of reduction in post-operative blood loss and reduced transfusion requirements * 精品ppt·实用可编辑 Pharmaceutical Intervention Aprotinin Significant elevation of celite ACT Two dosing regimens Full Hammersmith 2 x 106 KIU loading dose; 2 x 106 KIU pump prime; 0.5 x 106 KIU/hr infusion Half Hammersmith 1 x 106 KIU loading dose; 1 x 106 KIU pump prime; 0.25 x 106 KIU/hr infusion * 精品ppt·实用可编辑 ACT Monitoring with Aprotinin Treatment Celite ACT Not recommend