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Canadian Journal of Anesthesia

, Volume 48, Issue 9, pp 902–910 | Cite as

Reproductibilité et interchangeabilité du Thromboélastographe®, Sonoclot® et du temps de coagulation activé (Hémochron®), en chirurgie cardiaque

  • François Forestier
  • Sylvain Bélisle
  • Chantal Contant
  • François Harel
  • Gérard Janvier
  • Jean-François Hardy
Cardiothoracic Anesthesia, Respiration and Airway

Abstract

Objectif

Malgré une utilisation courante, la reproductibilité des mesures du Thromboélastographe® (TEG), du Sonoclot® (SCT), et de l’Hémochron® mesurant le temps de coagulation activé avec célite ou kaolin (ACT-C et ACT-K), a été peu étudiée dans les conditions réelles d’utilisation. La présente étude évalue la reproductibilité de ces mesures, et la possibilité de substituer l’ACT-C par un des autres tests.

Méthode

Les échantillons sanguins ont été prélevés chez 20 volontaires et 21 patients devant subir une revascularisation myocardique, et analysés dans deux canaux du TEG, deux SCT et quatre Hémochron®. Les tracés du TEG et du SCT ont été analysés respectivement par ordinateur et par un observateur expérimenté. Le pourcentage de variation (V %) pour chaque variable et l’interchangeabilité de l’ACT-K et du SCT avec l’ACT-C ont été évalués.

Résultats

Les V % de l’ACT-C et de l’ACT-K varient respectivement de 5,6 % à 10,8 % et de 6,7 % à 12,4 % selon les conditions. Les V % du TEG et du SCT varient respectivement de 3,1 % à 9,5 % et de 5,8 % à 33,6 %, selon les conditions et les paramètres étudiés. Aucun instrument ne peut se substituer à l’ACT-C en présence d’héparine et durant la circulation extracorporelle (CEC). Chez les volontaires et les malades non héparinisés, l’ACT-C et l’ACT-K sont interchangeables.

Conclusion

Dans des conditions réelles d’utilisation en chirurgie cardiaque, les mesures les plus reproductibles sont obtenues, dans un ordre décroissant, avec le TEG, l’Hémochron puis le SCT Les résultats des différents tests ne sont pas interchangeables chez le malade durant la CEC.

Reproducibility and interchangeability of the Thromboelastograph®, Sonoclot® and Hémochron® activated coagulation time in cardiac surgery

Abstract

Purpose

Despite their common use in cardiac surgery, few studies have evaluated the reproducibility of the Thromboelastograph® (TEG), of the Sonoclot® (SCT), and of the activated coagulation time with celite (ACT-C) or kaolin (ACT-K.) measured with the Hemochron®, in clinical conditions of on-site monitoring of hemostasis. This study determined the reproducibility of those measurements, and evaluated the ability of various devices to substitute for the ACTC.

Methods

Blood samples collected from 20 volunteers and 21 patients undergoing myocardial revascularization were analyzed in the two channels of the TEG, in two SCT and four Hemochron® analyzers. The overall of TEG and SCT coagulation profiles were analyzed by a computerized TEG and an experienced observer respectively. The variation rate (V%) was calculated for each variable. The ability of ACT-K and SCT to substitute for ACT-C under different clinical conditions was evaluated.

Results

ACT-C and ACT-K V% ranged between 5.6% and 10.8% and between 6.7% and 12.4% respectively. TEG and SCT V% ranged between 3.1 % and 9.5% and between 5.8% and 33.6% respectively, according to different conditions and parameters. In volunteers and nonheparinized patients, the ACT-C and ACT-K were interchangeable. No other test can substitute for the ACT-C when patients are heparinized during cardiopulmonary bypass (CPB).

Conclusions

In the clinical conditions of use, on-site hemostasis monitoring devices providing the most reproducible measurements are, in decreasing order, the TEG, the Hemochron® and the SCT. In heparinized patients and during CPB, results from different tests are not interchangeable, stressing the importance of establishing appropriate instrument-specific values for monitoring anticoagulation during cardiac surgery.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • François Forestier
    • 2
  • Sylvain Bélisle
    • 1
  • Chantal Contant
  • François Harel
    • 2
  • Gérard Janvier
    • 3
  • Jean-François Hardy
    • 1
  1. 1.Département d’anesthésieInstitut de Cardiologie de MontréalMontrealCanada
  2. 2.Département de biostatistiquesInstitut de Cardiologie de MontréalMontréalCanada
  3. 3.service d’anesthésie-réanimation chirurgicale IIC.H.U de BordeauxPessacFrance

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