Jeong H-W, Kwon H-M, Jung K-W, Moon Y-J, Jun I-G, Song J-G, Hwang G-S
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Transplant Proc. 2017 Jun;49(5):1076-1081. doi: 10.1016/j.transproceed.2017.03.042.
Measuring activated clotting time (ACT) is widely performed to monitor heparin therapy. Regardless of anticoagulant use, ACT is affected by coagulopathies such as coagulation factor deficiency and thrombocytopenia. However, its use in end-stage liver disease (ESLD) with complex coagulopathy is not well characterized. We evaluated whether ACT could be used to detect innate coagulopathy in ESLD patients.
We retrospectively assessed Hemochron (International Technidyne, Edison, NJ, USA) ACT (FTCA 510, normal range 105-167 seconds) and INTEM clotting time (CT) of rotational thromboelastometry (ROTEM; ROTEM delta, Pentapharm GmbH, Munich, Germany) (100-240 seconds) in 366 liver transplantation (LT) recipients, simultaneously measured before anesthetic induction for LT. Multiple linear regression analyses helped identify the factors related to ACT in ESLD patients. The relationship between ACT and INTEM CT was evaluated by Spearman rank correlation analysis and receiver operating characteristic curve.
Median ACT was 143 seconds (range 73-295 seconds), and 60 patients (16.4%) had ACTs of >167 seconds. Multiple regression analyses revealed that prolonged prothrombin time, activated partial thromboplastin time, low antithrombin III, and young age were associated with high ACT levels. INTEM CT was associated with ACT independent of liver disease severity, while EXTEM CT was not. ACT was moderately correlated with INTEM CT (r = 0.535), and the optimal cutoff value of ACT for predicting INTEM CT >240 seconds was 151 seconds (area under the curve = 0.787).
In ESLD patients, ACT is effective in detecting prolonged INTEM CT. Therefore, ACT may be used to predict intrinsic pathway defects with a cutoff value of 151 seconds, suggesting feasibility when ROTEM is unavailable.
测量活化凝血时间（ACT）广泛用于监测肝素治疗。无论是否使用抗凝剂，ACT都会受到诸如凝血因子缺乏和血小板减少等凝血病的影响。然而，其在伴有复杂凝血病的终末期肝病（ESLD）中的应用尚未得到充分描述。我们评估了ACT是否可用于检测ESLD患者的先天性凝血病。
我们回顾性评估了366例肝移植（LT）受者的Hemochron（美国新泽西州爱迪生市国际技术公司）ACT（FTCA 510，正常范围105 - 167秒）和旋转血栓弹力图（ROTEM；德国慕尼黑Pentapharm GmbH公司的ROTEM delta）的INTEM凝血时间（CT）（100 - 240秒），这些数据在LT麻醉诱导前同时测量。多元线性回归分析有助于确定ESLD患者中与ACT相关的因素。通过Spearman等级相关分析和受试者工作特征曲线评估ACT与INTEM CT之间的关系。
ACT中位数为143秒（范围73 - 295秒），60例患者（16.4%）的ACT>167秒。多元回归分析显示，凝血酶原时间延长、活化部分凝血活酶时间延长、抗凝血酶III水平低和年龄小与ACT水平高相关。INTEM CT与ACT相关，且独立于肝病严重程度，而EXTEM CT则不然。ACT与INTEM CT中度相关（r = 0.535），预测INTEM CT>240秒时ACT的最佳截断值为151秒（曲线下面积 = 0.787）。
在ESLD患者中，ACT可有效检测延长的INTEM CT。因此，ACT可用于预测内源性途径缺陷，截断值为151秒，这表明在无法使用ROTEM时具有可行性。
