PMID- 25248688
OWN - NLM
STAT- MEDLINE
DCOM- 20150720
LR  - 20141202
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 134
IP  - 5
DP  - 2014 Nov
TI  - Underestimation of unfractionated heparin therapy assessment due to platelet 
      activation when using partial-draw (pediatric) citrate collection tubes.
PG  - 1117-22
LID - S0049-3848(14)00448-4 [pii]
LID - 10.1016/j.thromres.2014.08.012 [doi]
AB  - The "so-called" pediatric tubes are often used when collecting smaller blood 
      volume is necessary, particularly in pediatric patients or in case of 
      difficult/recurrent sampling. The aim of this multicenter study was to compare 
      coagulation test results evaluated in evacuated polymer tubes containing 0.109 M 
      citrate (1 vol./9 vol.) specifically designed to allow either a partial (2.0 
      mL,"pediatric") or a total (3.5 mL) filling. No significantly relevant 
      discrepancy was found between routine coagulation test results in both tubes 
      collected from untreated patients and from patients on vitamin K antagonist or 
      low molecular weight heparin. In contrast, aPTT was significantly shorter and 
      anti-FXa activity was significantly lower in partial-draw than in full-draw tubes 
      collected from 46 patients receiving unfractionated heparin (UFH). This 
      discrepancy was likely related to increased platelet activation in partial-draw 
      tubes, as suggested by higher platelet factor 4 plasma concentrations and 
      platelet P-Selectin expression in partial-draw than in full-draw citrate tubes. 
      To confirm this hypothesis, we then evaluated partial-draw tubes containing CTAD, 
      a mixture of anticoagulant and antiplatelet agents. In 25 patients on UFH, aPTT 
      and anti-FXa activity were not significantly different in partial-draw CTAD tubes 
      and in full-draw citrate tubes. In conclusion, despite increased platelet 
      activation, samples collected into partial-draw citrate tubes allow accurate 
      routine coagulation testing in all patients but those requiring UFH assessment, 
      in which their use could lead to significant underestimation of anticoagulation. 
      In such cases, partial-draw tubes containing CTAD could be validly used to 
      monitor heparin therapy as well as to perform routine coagulation testing.
CI  - Copyright (c) 2014. Published by Elsevier Ltd.
FAU - Desconclois, Celine
AU  - Desconclois C
AD  - Service d'Hematologie Biologique, CHU Bicetre, AP-HP, Universite Paris-Sud, Le 
      Kremlin-Bicetre, France.
FAU - Eschwege, Valerie
AU  - Eschwege V
AD  - Service d'Hematologie Biologique, CHU Saint-Antoine, AP-HP, Paris, France.
FAU - Proulle, Valerie
AU  - Proulle V
AD  - Service d'Hematologie Biologique, CHU Bicetre, AP-HP, Universite Paris-Sud, Le 
      Kremlin-Bicetre, France.
FAU - Boutekedjiret, Tewfik
AU  - Boutekedjiret T
AD  - Service d'Hematologie Biologique, CHU Bicetre, AP-HP, Universite Paris-Sud, Le 
      Kremlin-Bicetre, France.
FAU - Dreyfus, Marie
AU  - Dreyfus M
AD  - Service d'Hematologie Biologique, CHU Bicetre, AP-HP, Universite Paris-Sud, Le 
      Kremlin-Bicetre, France.
FAU - Toulon, Pierre
AU  - Toulon P
AD  - Universite Nice Sofia-Antipolis, CHU Saint Roch, Service d'Hematologie 
      Biologique, Nice, France. Electronic address: toulon.p@chu-nice.fr.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140827
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 2968PHW8QP (Citric Acid)
RN  - 37270-94-3 (Platelet Factor 4)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Blood Platelets/cytology/*drug effects/metabolism
MH  - Blood Specimen Collection/*instrumentation
MH  - Citric Acid/chemistry
MH  - Drug Monitoring/*instrumentation
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Platelet Activation/*drug effects
MH  - Platelet Factor 4/metabolism
OTO - NOTNLM
OT  - CTAD
OT  - Citrate
OT  - Full-draw tubes
OT  - Heparin therapy
OT  - Monitoring
OT  - Partial-draw tubes
EDAT- 2014/09/25 06:00
MHDA- 2015/07/21 06:00
CRDT- 2014/09/25 06:00
PHST- 2014/04/10 00:00 [received]
PHST- 2014/08/15 00:00 [revised]
PHST- 2014/08/17 00:00 [accepted]
PHST- 2014/09/25 06:00 [entrez]
PHST- 2014/09/25 06:00 [pubmed]
PHST- 2015/07/21 06:00 [medline]
AID - S0049-3848(14)00448-4 [pii]
AID - 10.1016/j.thromres.2014.08.012 [doi]
PST - ppublish
SO  - Thromb Res. 2014 Nov;134(5):1117-22. doi: 10.1016/j.thromres.2014.08.012. Epub 
      2014 Aug 27.