PMID- 31904611
OWN - NLM
STAT- MEDLINE
DCOM- 20200603
LR  - 20210203
IS  - 1473-5733 (Electronic)
IS  - 0957-5235 (Linking)
VI  - 31
IP  - 1
DP  - 2020 Jan
TI  - Confounding effect of therapeutic protamine and heparin levels on routine and 
      special coagulation testing.
PG  - 60-64
LID - 10.1097/MBC.0000000000000882 [doi]
AB  - : The management of a patient with hemophilia undergoing cardiovascular surgery 
      relies on accurate coagulation test results. Both unfractionated heparin (UFH) 
      and protamine sulfate used during cardiac surgery can interfere with factor and 
      inhibitor assays. Here we describe the effects of UFH and protamine sulfate on 
      routine coagulation, factor activity, and inhibitor assays. Pooled normal plasma 
      (PNP) with UFH, PNP with protamine sulfate, PNP with both protamine sulfate and 
      UFH were tested for the activated partial thromboplastin time (aPTT), prothrombin 
      time (PT), thrombin time (TT), UFH anti-Xa, one-stage factor VIII (FVIII) 
      activity, one-stage factor IX (FIX) activity, and Bethesda inhibitor assays for 
      FVIII and FIX. UFH had a dose-dependent effect with TT, aPTT, and PT. On Bethesda 
      inhibitor testing, FIX inhibition was detected at 1 U/ml UFH and 3 U/ml UFH for 
      FVIII. Increasing protamine sulfate concentration in PNP prolonged the PT and 
      aPTT in a dose-dependent manner, decreased FVIII and FIX activity and did not 
      affect TT or UFH anti-Xa. At protamine sulfate doses of at least 200 mug/ml there 
      was weak FVIII and FIX inhibition detected. At lower ratios of protamine sulfate 
      to UFH (0.6 : 1-0.8 : 1), the aPTT decreased, suggesting reversal of UFH. 
      However, at protamine sulfate to UFH ratios of 1.0 : 1 and higher, aPTT 
      prolongation was observed. Inhibition of FVIII and FIX was detected at low ratios 
      of protamine sulfate to UFH (below 0.4 : 1) and disappeared at higher ratios. UFH 
      and protamine sulfate, alone or in combination, impact factor activity and 
      inhibitor testing for both FVIII and FIX. Hence, factor activity and inhibitor 
      assay results should be interpreted with caution when UFH or protamine sulfate 
      are present.
FAU - Khandelwal, Aditi
AU  - Khandelwal A
AD  - Fellow, Transfusion Medicine, Department of Laboratory Medicine and Pathology, 
      University of Toronto and Canadian Blood Services, Toronto.
FAU - Phua, Chai W
AU  - Phua CW
AD  - Division of Hematology, Department of Medicine, London Health Sciences Centre, 
      London.
FAU - Chaudhry, Hina R
AU  - Chaudhry HR
AD  - Department of Hematology and Laboratory Medicine, St. Michael's Hospital, 
      Toronto.
FAU - Tsui, Hubert
AU  - Tsui H
AD  - Hematological Pathology, Department of Laboratory Hematology, Toronto General 
      Hospital, University Health Network, Toronto, Ontario.
FAU - Rivard, Georges E
AU  - Rivard GE
AD  - Department of Hematology-Oncology, Centre Hospitalier Universitaire 
      Sainte-Justine, Montreal, Quebec.
FAU - Teitel, Jerome M
AU  - Teitel JM
AD  - Division of Hematology, Department of Medicine, St. Michael's Hospital.
FAU - Sholzberg, Michelle
AU  - Sholzberg M
AD  - Division of Hematology, Departments of Medicine and Laboratory Medicine & 
      Pathobiology, St. Michael's Hospital, Li Ka Shing Knowledge Institute, University 
      of Toronto, Toronto, Ontario, Canada.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Blood Coagul Fibrinolysis
JT  - Blood coagulation & fibrinolysis : an international journal in haemostasis and 
      thrombosis
JID - 9102551
RN  - 0 (Anticoagulants)
RN  - 0 (Protamines)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/pharmacology/*therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - Blood Coagulation Tests/*methods
MH  - Heparin/pharmacology/*therapeutic use
MH  - Humans
MH  - Middle Aged
MH  - Protamines/pharmacology/*therapeutic use
EDAT- 2020/01/07 06:00
MHDA- 2020/06/04 06:00
CRDT- 2020/01/07 06:00
PHST- 2020/01/07 06:00 [pubmed]
PHST- 2020/06/04 06:00 [medline]
PHST- 2020/01/07 06:00 [entrez]
AID - 00001721-202001000-00009 [pii]
AID - 10.1097/MBC.0000000000000882 [doi]
PST - ppublish
SO  - Blood Coagul Fibrinolysis. 2020 Jan;31(1):60-64. doi: 
      10.1097/MBC.0000000000000882.