Neurocrit Care DOI 10.1007/s12028-014-0023-7
REVIEW ARTICLE
Monitoring of Hematological and Hemostatic Parameters in Neurocritical Care Patients Andrew M. Naidech • Monisha A. Kumar • And the Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring
Ó Springer Science+Business Media New York 2014
Abstract Anemia and bleeding are paramount concerns in neurocritical care and often relate to the severity of intracranial hemorrhage. Anemia is generally associated with worse outcomes, and efforts to minimize anemia through reduced volume of blood sampled are encouraged. Point-of-care-testing reliably detects the use of non-steroidal anti-inflammatory drugs that may worsen bleeding and reduce platelet activity, particularly in patients with intracerebral hemorrhage. How best to monitor the effect of platelet transfusion or platelet-activating therapy is not well studied. For patients known to take novel oral anticoagulants, drug-specific coagulation tests before neurosurgical intervention are prudent. Keywords Anemia Transfusion Point-of-care test Platelet Coagulation Thrombosis Platelet function assay
Introduction Hemoglobin (Hgb) monitoring is a routine part of critical care as anemia and bleeding are common complications encountered in the intensive care unit (ICU). Anemia may lead to cerebral ischemia, organ hypoperfusion, multiorgan failure, and death. Monitoring of coagulation is important to A. M. Naidech (&) Departments of Neurology, Neurosurgery, Northwestern University, Chicago, IL, USA e-mail: [email protected] M. A. Kumar Departments of Neurology, Neurosurgery and Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
minimize peri-operative bleeding risk, monitor systemic anticoagulation, prevent hematoma expansion, and assess hematological derangements. Point-of-care testing (POCT) may optimize the delivery and efficiency of ICU care; however, concerns regarding accuracy, validity, and cost persist.
Methods Using the PubMed database, a systematic review was performed (1980–December 2013) according to the preferred reporting items for systematic reviews and metaanalyses statement. The quality of available evidence was evaluated based on the GRADE system. Recommendations were classified as either strong or weak. The quality of evidence was rated as high if further research was deemed very unlikely to change confidence in the estimate of effect. Quality was rated as moderate if further research was thought to have an important impact on confidence in the estimate of effect and may change the estimate, and low if further research was thought very likely to have an important impact on confidence in the estimate of effect and was likely to change the estimate. Evidence was rated very low quality if the estimate of effect remained very uncertain. Where inadequate evidence was available for review, no recommendation was attempted. Search Criteria The search strategy included the terms: Hgb, hematocrit (Hct), anemia, transfusion, platelets, brain injury, traumatic brain injury (and related terms: head trauma, neurotrauma, head injury), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), acute ischemic stroke, large hemispheric infarction, malignant middle cerebral artery infarction, anemia,
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Neurocrit Care
ischemia, secondary ischemia, cerebral ischemia, brain ischemia, delayed cerebral ischemia (DCI), and vasospasm. Study Selection and Data Collection We restricted articles to those published in the English language. We excluded: (a) review articles; (b) case reports or case series with B5 patients; (c) experimental studies; (d) studies on pediatric ICU populations (
REVIEW ARTICLE
Monitoring of Hematological and Hemostatic Parameters in Neurocritical Care Patients Andrew M. Naidech • Monisha A. Kumar • And the Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring
Ó Springer Science+Business Media New York 2014
Abstract Anemia and bleeding are paramount concerns in neurocritical care and often relate to the severity of intracranial hemorrhage. Anemia is generally associated with worse outcomes, and efforts to minimize anemia through reduced volume of blood sampled are encouraged. Point-of-care-testing reliably detects the use of non-steroidal anti-inflammatory drugs that may worsen bleeding and reduce platelet activity, particularly in patients with intracerebral hemorrhage. How best to monitor the effect of platelet transfusion or platelet-activating therapy is not well studied. For patients known to take novel oral anticoagulants, drug-specific coagulation tests before neurosurgical intervention are prudent. Keywords Anemia Transfusion Point-of-care test Platelet Coagulation Thrombosis Platelet function assay
Introduction Hemoglobin (Hgb) monitoring is a routine part of critical care as anemia and bleeding are common complications encountered in the intensive care unit (ICU). Anemia may lead to cerebral ischemia, organ hypoperfusion, multiorgan failure, and death. Monitoring of coagulation is important to A. M. Naidech (&) Departments of Neurology, Neurosurgery, Northwestern University, Chicago, IL, USA e-mail: [email protected] M. A. Kumar Departments of Neurology, Neurosurgery and Anesthesiology & Critical Care, University of Pennsylvania, Philadelphia, PA, USA
minimize peri-operative bleeding risk, monitor systemic anticoagulation, prevent hematoma expansion, and assess hematological derangements. Point-of-care testing (POCT) may optimize the delivery and efficiency of ICU care; however, concerns regarding accuracy, validity, and cost persist.
Methods Using the PubMed database, a systematic review was performed (1980–December 2013) according to the preferred reporting items for systematic reviews and metaanalyses statement. The quality of available evidence was evaluated based on the GRADE system. Recommendations were classified as either strong or weak. The quality of evidence was rated as high if further research was deemed very unlikely to change confidence in the estimate of effect. Quality was rated as moderate if further research was thought to have an important impact on confidence in the estimate of effect and may change the estimate, and low if further research was thought very likely to have an important impact on confidence in the estimate of effect and was likely to change the estimate. Evidence was rated very low quality if the estimate of effect remained very uncertain. Where inadequate evidence was available for review, no recommendation was attempted. Search Criteria The search strategy included the terms: Hgb, hematocrit (Hct), anemia, transfusion, platelets, brain injury, traumatic brain injury (and related terms: head trauma, neurotrauma, head injury), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), acute ischemic stroke, large hemispheric infarction, malignant middle cerebral artery infarction, anemia,
123
Neurocrit Care
ischemia, secondary ischemia, cerebral ischemia, brain ischemia, delayed cerebral ischemia (DCI), and vasospasm. Study Selection and Data Collection We restricted articles to those published in the English language. We excluded: (a) review articles; (b) case reports or case series with B5 patients; (c) experimental studies; (d) studies on pediatric ICU populations (
