PMID- 23041210
OWN - NLM
STAT- MEDLINE
DCOM- 20130517
LR  - 20121126
IS  - 1873-3492 (Electronic)
IS  - 0009-8981 (Linking)
VI  - 414
DP  - 2012 Dec 24
TI  - Monitoring of unfractionated heparin with rotational thrombelastometry using the 
      prothrombinase-induced clotting time reagent (PiCT(R)).
PG  - 202-5
LID - S0009-8981(12)00464-0 [pii]
LID - 10.1016/j.cca.2012.09.029 [doi]
AB  - PURPOSE: To achieve sufficient and safe anticoagulation with unfractionated 
      heparin (UFH) a close and reliable drug monitoring is necessary. In general, the 
      activated partial thromboplastin time (APTT) is used for this purpose. In acute 
      phase response, however, the APTT test procedure might be unreliable e.g. with 
      false low results in the presence of elevated factor VIII. In this so called 
      heparin resistance, measurement of anti-Xa activity is recommended over APTT to 
      avoid potentially harmful dose escalation. A combination of anti-Xa measurement 
      and global hemostatic testing with ROTEM(R) employing the anti-Xa sensitive PiCT(R) 
      reagent showed high correlation with enoxaparin levels. This test modification 
      could also be suitable for monitoring UFH. Aim of the study was to evaluate the 
      correlation between PiCT(R)-ROTEM(R) and levels of UFH. METHODS: In this in-vitro 
      study blood samples from healthy volunteers were spiked with UFH and subjected to 
      different ROTEM(R) tests. RESULTS: There was a linear correlation between UFH level 
      and clotting time (CT) in the PiCT(R)-ROTEM(R) test with an excellent correlation 
      coefficient of 0.92. Additional endpoints showed similar results (PiCT(R)-ROTEM(R) 
      MaxVel r = -0.85 and PiCT(R)-ROTEM(R) t_MaxVel r = 0.88). CONCLUSIONS: As a 
      point-of-care applicable tool ROTEM(R) is immediately at hand. If further clinical 
      studies confirm sensitivity in heparin resistance, PiCT(R)-ROTEM(R) could permit 
      rapid UFH dose adjustments especially required in critical illness with acute 
      phase response.
CI  - Copyright (c) 2012 Elsevier B.V. All rights reserved.
FAU - Schaden, E
AU  - Schaden E
AD  - Dept of Anesthesiology, General Intensive Care and Pain Control, Medical 
      University of Vienna, Vienna, Austria. eva.schaden@meduniwien.ac.at
FAU - Jilch, S
AU  - Jilch S
FAU - Hacker, S
AU  - Hacker S
FAU - Schober, A
AU  - Schober A
FAU - Kozek-Langenecker, S
AU  - Kozek-Langenecker S
LA  - eng
PT  - Journal Article
DEP - 20121002
PL  - Netherlands
TA  - Clin Chim Acta
JT  - Clinica chimica acta; international journal of clinical chemistry
JID - 1302422
RN  - 9005-49-6 (Heparin)
RN  - 9035-58-9 (Thromboplastin)
SB  - IM
MH  - Adult
MH  - *Blood Coagulation Tests
MH  - Female
MH  - Heparin/*blood
MH  - Humans
MH  - Male
MH  - Reference Values
MH  - Rotation
MH  - Sensitivity and Specificity
MH  - *Thrombelastography
MH  - Thromboplastin/*metabolism
EDAT- 2012/10/09 06:00
MHDA- 2013/05/18 06:00
CRDT- 2012/10/09 06:00
PHST- 2012/05/30 00:00 [received]
PHST- 2012/09/06 00:00 [revised]
PHST- 2012/09/25 00:00 [accepted]
PHST- 2012/10/09 06:00 [entrez]
PHST- 2012/10/09 06:00 [pubmed]
PHST- 2013/05/18 06:00 [medline]
AID - S0009-8981(12)00464-0 [pii]
AID - 10.1016/j.cca.2012.09.029 [doi]
PST - ppublish
SO  - Clin Chim Acta. 2012 Dec 24;414:202-5. doi: 10.1016/j.cca.2012.09.029. Epub 2012 
      Oct 2.