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The Accuracy of Coagulation Testing

Horlocker, Terese T. MD; Nuttall, Gregory A. MD

doi: 10.1097/00000539-200205000-00079
LETTERS TO THE EDITOR: Letters & Announcements

Department of Anesthesiology

Mayo Clinic

Rochester, MN

In Response:

We would like to thank Drs. Cooper and McLeod for their thoughtful letter. Although allocation of groups based on recorded surgical impressions of bleeding could lead to unrepresentative data sampling, observation of the surgical field is the first and most important determinant of the need for transfusion of non-red blood cell products (1). When increased surgical bleeding, defined as recurrent bleeding despite adequate use of electrocautery and suture or decreased clot formation within the field is noted, coagulation tests are performed to confirm the existence of a coagulopathy and to determine which non-red blood cell products are needed to correct the disorder. Conversely, routine assessment of coagulation studies in the absence of a clinical clotting abnormality would have limited usefulness. This later point also explains why only 5% of patients in the group without increased bleeding had coagulation tests performed. We agree that prospective studies are needed to further define the mechanisms of coagulopathy and the role of coagulation testing during major spine surgery. Our retrospective analysis provides direction on which coagulation tests may be most useful in the development of evidence-based guidelines for blood component therapy.

Terese T. Horlocker, MD

Gregory A. Nuttall, MD

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1. Nuttall GA, Oliver WC, Santrach PJ, et al. Efficacy of a simple intraoperative transfusion algorithm for nonerythrocyte component utilization after cardiopulmonary bypass. Anesthesiology 2001; 94: 773–81.
© 2002 International Anesthesia Research Society