Point-of-care coagulation management in intensive care medicine

Coagulopathy in critically ill patients is common and of multifactorial origin [1]. Coagulopathy-associated risk of bleeding and the use of allogeneic blood pro ducts are independent risk factors for morbidity and mortality [2,3]. Th erefore, prompt and correct identifi cation of the underlying causes of these coagulation abnormalities is required, since each coagulation abnormality necessitates very diff erent therapeutic management strategies. St andard laboratory tests of blood coagulation yield only partial diagnostic information, and important coagulation defects, e.g., reduced clot stability, platelet dysfunction, or hyperfi brinolysis, remain undetected. Th erefore, point-of-care (POC) diagnostics are increasingly being used for rapid specifi c testing of hemostatic function. Algorithm-based hemotherapy, including POC techniques, reliably corrects coagulopathy, but may also have the potential to reduce blood loss, transfusion requirements and risk of transfusion-related adverse events, prevent thromboembolic events, and save costs. Th is article reviews the most frequent coagulation abnor malities in critically ill patients. In particular, we will discuss diff erential diagnoses, benefi ts and limitations of POC coagulation management and hemotherapy al gorithms.