Monitoring direct thrombin inhibitors with a plasma diluted thrombin time
| Autor: | Wayne L. Chandler, Chris Ferrell, Jason E. Love |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Chromatography medicine.diagnostic_test Chemistry Hematology Thrombin time Lepirudin Argatroban Thrombin Endocrinology Therapeutic drug monitoring Internal medicine medicine Bivalirudin circulatory and respiratory physiology medicine.drug Discovery and development of direct thrombin inhibitors Partial thromboplastin time |
| Zdroj: | Thrombosis and Haemostasis. 98:234-242 |
| ISSN: | 2567-689X 0340-6245 |
| DOI: | 10.1160/th06-10-0607 |
| Popis: | SummaryActivated partial thromboplastin time (aPTT) monitoring of direct thrombin inhibitors (DTIs) is vulnerable to interference from many sources. If the baseline aPTT is prolonged, as occurs with lupus inhibitors, alternative methods are required to monitor DTI levels. We compared the plasma diluted thrombin time (1:4 dilution of patient plasma with normal plasma) and the aPTT in patient samples spiked with argatroban, bivalirudin, or lepirudin at three concentration levels. Each drug was spiked into five samples with lupus inhibitors, five samples with deficient vitamin K-dependent factors, three samples with elevated D-dimers, and eight samples with normal baseline aPTT values. The aPTT overestimated the spiked DTI concentration in all samples with lupus inhibitors, low levels of vitamin K-dependent factors, and elevated D-dimers. In samples with normal baseline aPTTs, the aPTT failed to correctly estimate the spiked drug concentration in four of 24 samples spiked with argatroban, seven of 24 spiked with lepirudin, and three of 24 spiked with bivalirudin. The plasma diluted thrombin time was not affected by lupus inhibitors, low vitamin K-dependent factor levels or elevated D-dimer levels and correctly estimated the spiked drug level in 63 of 63 samples spiked with argatroban, 63 of 63 samples spiked with bivalirudin, and 62 of 63 samples spiked with lepirudin. In conclusion, the plasma diluted thrombin time appears to be a viable alternative to the aPTT for monitoring DTI levels, especially in patients with lupus inhibitors or low levels of vitamin K-dependent factors. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|