Gähler Anita, Wuillemin Walter A
Abteilung für Hämatologie und Hämatologisches Zentrallabor, Luzerner Kantonsspital, Luzern.
Ther Umsch. 2013 Aug;70(8):443-8. doi: 10.1024/0040-5930/a000430.
Coagulation assays are prone to pre-analytical problems and results may be influenced by varying clinical and pharmaceutical aspects. Particularly anticoagulants interact with coagulation testing in many ways. Thromboplastin time will be prolonged dose-dependently in patients taking vitamin K antagonists; moreover the new oral anticoagulants have been shown to have variable impact on the results of the thromboplastin time as well as on other coagulation tests, depending on the mechanism of action of these new drugs as well as on the mechanism of the coagulation test. When measuring anti-Xa activity it should be realised that all drugs with anti-Xa activity will influence the result, which means not only heparins but also the new anti-Xa inhibitors. Respective calibration curves are an indispensable condition to provide the clinician with valuable results. On the other hand this implies that the laboratory knows which anticoagulant is given to the patient. This is an example among others that clinical aspects are important to know for proper interpretation of the results of coagulation testing. Other examples are e. g. bleeding disorders, actual bleeding status or thromboembolic events. Several cases are discussed which exemplify possible pitfalls in the interpretation of coagulation testing.
凝血检测容易出现分析前问题,其结果可能会受到不同临床和药物因素的影响。特别是抗凝剂会在许多方面与凝血检测相互作用。服用维生素K拮抗剂的患者,凝血酶原时间会呈剂量依赖性延长;此外,新型口服抗凝剂已被证明对凝血酶原时间以及其他凝血检测结果有不同程度的影响,这取决于这些新药的作用机制以及凝血检测的机制。在检测抗Xa活性时,应认识到所有具有抗Xa活性的药物都会影响结果,这不仅包括肝素,还包括新型抗Xa抑制剂。相应的校准曲线是为临床医生提供有价值结果的必不可少的条件。另一方面,这意味着实验室要知道患者正在使用哪种抗凝剂。这只是一个例子,说明了解临床情况对于正确解读凝血检测结果很重要。其他例子如出血性疾病、实际出血状态或血栓栓塞事件等。文中讨论了几个案例,这些案例例证了在解读凝血检测结果时可能出现的陷阱。