Tsimikas S, Beyer R, Hassankhani A
Division of Cardiovascular Diseases, Department of Medicine, University of California San Diego, 9500 Gilman Drive, BSB 1080, La Jolla, CA 92093-0682, USA.
J Thromb Thrombolysis. 2001 May;11(3):217-21. doi: 10.1023/a:1011908803939.
Point-of-care whole blood coagulation tests are critical in the management of patients who undergo percutaneous coronary intervention. The Hemochron and HemoTec devices have been traditionally used to measure the activated clotting time (ACT) in the cardiac catheterization laboratory. The heparin management test (HMT) was recently introduced into clinical practice as an alternative method to current ACT measurements that uses a different sample volume, contact activators and detection system to measure whole blood coagulation. We compared the HMT to the HemoTec ACT in 68 prospectively enrolled patients (127 blood samples) undergoing percutaneous coronary intervention. Measurements were performed 10 minutes after the initial heparin bolus and thereafter at the discretion of the attending physician. The mean HMT was 41 seconds higher (approximately 15%) than the HemoTec ACT (HMT 304+/-59 vs. ACT 263+/-52, P< 0.0001), but there was a significant correlation between the methods (r=0.77, P<0.0001). However, there was increasing disagreement between the two methods as the level of anticoagulation increased. The relationship between HMT and ACT was similar in patients in whom glycoprotein IIb/IIIa inhibitors were used. The HMT, therefore, appears to be more sensitive to heparin anticoagulation that the HemoTec ACT and correlates well with it in the range required for percutaneous coronary intervention.
即时全血凝血检测对于接受经皮冠状动脉介入治疗的患者的管理至关重要。传统上，Hemochron和HemoTec设备用于在心脏导管实验室测量活化凝血时间（ACT）。肝素管理测试（HMT）最近被引入临床实践，作为当前ACT测量的替代方法，它使用不同的样本量、接触激活剂和检测系统来测量全血凝血。我们在68例接受经皮冠状动脉介入治疗的前瞻性入组患者（127份血样）中比较了HMT和HemoTec ACT。在初始推注肝素后10分钟进行测量，此后由主治医师酌情决定测量时间。HMT的平均值比HemoTec ACT高41秒（约15%）（HMT 304±59 vs. ACT 263±52，P<0.0001），但两种方法之间存在显著相关性（r=0.77，P<0.0001）。然而，随着抗凝水平的增加，两种方法之间的差异越来越大。在使用糖蛋白IIb/IIIa抑制剂的患者中，HMT与ACT之间的关系相似。因此，HMT似乎比HemoTec ACT对肝素抗凝更敏感，并且在经皮冠状动脉介入治疗所需的范围内与它具有良好的相关性。
