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

[Reproducibility and interchangeability of the Thromboelastograph®, Sonoclot® and Hemochron® activated coagulation time in cardiac surgery]

François Forestier, MD, Sylvain Bélisle, MD^*, Chantal Contant, MD^*, François Harel, MSc, Gérard Janvier, MD and Jean-François Hardy, MD^*

^* Des départements D'anesthésiologie, Et De Biostatistiques,
Institut de Cardiologie de Montréal, Montréal, Québec, Canada; Et Le Service D'anesthésie-Réanimation Chirurgicale II,
C.H.U de Bordeaux, Pessac, France.

Adresser la correspondance à: Dr. Sylvain Bélisle, Département d'anesthésie, Institut de Cardiologie de Montréal, 5000 rue Bélanger est, Montreal, Quebec H1T 1C8, Canada. Phone: 514-376-3330; Fax: 514-376-8784; E-mail: sylvain.belisle2{at}sympatico.ca

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 ACT-C.

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 non-heparinized 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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