Evaluating a patient's coagulation status helps the nurse anticipate potentially life threatening consequences of hemostatic imbalance. Hemostatic imbalance can increase the risk of hemorrhage or embolus formation.
Coagulation tests such as the prothrombin time (PT), activated partial thromboplastin time (aPTT), and the activated clotting time (ACT) are important tools used to evaluate and monitor hemostasis and the efficacy of anticoagulation therapy.
Safe nursing evaluation of a patient's hemostatic status involves:
Historically, evaluation of hemostasis has been based upon the time required for clot formation. Bleeding time, PT, aPTT and ACT are all based upon the time it takes for a clot to be sensed either by the tester or the lab equipment.
Today, advances in molecular science are providing new tools to evaluate individual steps in the cascade process. Labs can now evaluate the levels of individual proteins, cofactors and enzymes necessary for coagulation. These tests often use synthetic markers which bind to the target molecules. The marked molecule can then be quantified. These tests allow more accurate and timely therapeutic response.
Advances are also being made in moving tests to the patient's bedside. Bedside evaluation eliminates transport and backlog delays that occur in central laboratory processing. Currently, cost and variations in sampling technique are limiting the application of theses devices.
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