Carroll Roger C, Chavez Jack J, Simmons Jeffery W, Snider Carolyn C, Wortham Dale C, Bresee Stuart J, Cohen Eli
Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee 37920, USA.
Anesth Analg. 2006 May;102(5):1316-9. doi: 10.1213/01.ane.0000205746.50440.98.
Standard activated clotting time (ACT) tests have a poor correlation to bivalirudin levels, leading to uncertainty regarding adequate anticoagulation in percutaneous coronary intervention patients. We tested a Thrombelastograph (TEG) ecarin clotting time (ECT) assay for sensitivity to bivalirudin using blood from 80 patients undergoing interventional cardiology procedures with bivalirudin anticoagulation. This was compared to a standard Hemochron ACT assay using diatomaceous earth. With the TEG assay, the direct thrombin activator, ecarin, was used to initiate coagulation and measured as the reaction time. Plasma samples were evaluated for bivalirudin by a chromogenic assay at an independent hematological laboratory. Linear regression of the standard ACT versus bivalirudin level gave an r = 0.306 whereas the TEG ECT gave a much higher r2 = 0.746 (both P < 0.0001). The TEG ECT should prove more useful than the standard ACT for monitoring bivalirudin anticoagulation across the clinically therapeutic range.
标准活化凝血时间（ACT）检测与比伐卢定水平的相关性较差，这导致经皮冠状动脉介入治疗患者的抗凝是否充分存在不确定性。我们使用来自80例接受比伐卢定抗凝的介入心脏病学手术患者的血液，测试了血栓弹力图（TEG）蛇静脉酶凝血时间（ECT）检测对比伐卢定的敏感性。将其与使用硅藻土的标准Hemochron ACT检测进行比较。在TEG检测中，直接凝血酶激活剂蛇静脉酶用于启动凝血，并将反应时间作为测量指标。血浆样本在独立血液学实验室通过显色测定法评估比伐卢定水平。标准ACT与比伐卢定水平的线性回归得出r = 0.306，而TEG ECT得出的r2值高得多，为0.746（两者P < 0.0001）。在临床治疗范围内监测比伐卢定抗凝时，TEG ECT应比标准ACT更有用。
