PMID- 14693175
OWN - NLM
STAT- MEDLINE
DCOM- 20040826
LR  - 20191210
IS  - 0049-3848 (Print)
IS  - 0049-3848 (Linking)
VI  - 111
IP  - 4-5
DP  - 2003
TI  - Dextran sulfate included in factor Xa assay reagent overestimates heparin 
      activity in patients after heparin reversal by protamine.
PG  - 273-9
AB  - A lack of correlation between activated partial thromboplastin time (aPTT), 
      thrombin time (TT) and anti-factor Xa (AXa) activity was observed in patients 
      after cardiac surgery with cardiopulmonary bypass (CBP). Indeed, AXa activity 
      measured by the chromogenic assay, Coamatic Heparin, was higher than expected 
      with regard to results obtained in coagulation assays. To account for this 
      discrepancy, another AXa chromogenic assay was tested. First, AXa activity was 
      measured with two chromogenic assays (Coamatic Heparin and Rotachrom Heparin) in 
      plasma samples of 25 patients undergoing cardiac surgery at two time points after 
      heparin reversal by protamine. AXa activity was significantly higher when 
      measured with Coamatic Heparin than with Rotachrom Heparin in samples collected 
      just after protamine infusion (p<0.01). Next, since Coamatic( Heparin contains 
      dextran sulfate (DXS) to reduce the influence of heparin antagonists such as 
      platelet factor 4 (PF4), whereas Rotachrom Heparin does not, we hypothesized that 
      the dextran sulfate contained in the reagent might explain this discrepancy. We 
      therefore performed in vitro studies consisting in neutralizing unfractionated 
      heparin (UFH) with protamine and measuring AXa activity with the two chromogenic 
      assays. An AXa activity was still measurable with Coamatic Heparin after 
      neutralization, thus strongly suggesting that dextran sulfate dissociates 
      protamine/heparin complexes. We conclude that Coamatic Heparin assays should be 
      avoided when measuring AXa activity in plasma samples immediately after protamine 
      infusion, as inaccurate results may lead to inadequate management of heparin 
      reversal.
FAU - Mouton, Christine
AU  - Mouton C
AD  - Haemobiology Laboratory, Cardiologic Hospital, C.H.U de Bordeaux, Avenue 
      Magellan, Pessac 33604, France. christine.muton@chu-bordeaux.fr
FAU - Calderon, Joachim
AU  - Calderon J
FAU - Janvier, Gerard
AU  - Janvier G
FAU - Vergnes, Marie-Christine
AU  - Vergnes MC
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PT  - Validation Study
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Chromogenic Compounds)
RN  - 0 (Heparin Antagonists)
RN  - 0 (Indicators and Reagents)
RN  - 0 (Protamines)
RN  - 0 (Reagent Kits, Diagnostic)
RN  - 9005-49-6 (Heparin)
RN  - 9042-14-2 (Dextran Sulfate)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Anticoagulants/blood/chemistry/therapeutic use
MH  - Blood Coagulation Tests/methods
MH  - Cardiovascular Surgical Procedures/adverse effects
MH  - Chromogenic Compounds/analysis/chemistry
MH  - Dextran Sulfate/*blood/chemistry
MH  - Factor Xa/*analysis/chemistry
MH  - Heparin/*blood/chemistry/therapeutic use
MH  - Heparin Antagonists/blood/chemistry/therapeutic use
MH  - Humans
MH  - Indicators and Reagents/chemistry
MH  - Protamines/*blood/chemistry/therapeutic use
MH  - Reagent Kits, Diagnostic
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Thrombosis/etiology/prevention & control
EDAT- 2003/12/25 05:00
MHDA- 2004/08/27 05:00
CRDT- 2003/12/25 05:00
PHST- 2003/12/25 05:00 [pubmed]
PHST- 2004/08/27 05:00 [medline]
PHST- 2003/12/25 05:00 [entrez]
AID - S0049384803004961 [pii]
AID - 10.1016/j.thromres.2003.09.014 [doi]
PST - ppublish
SO  - Thromb Res. 2003;111(4-5):273-9. doi: 10.1016/j.thromres.2003.09.014.