Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Platelets. 2020;31(2):215-220. doi: 10.1080/09537104.2019.1595562. Epub 2019 Apr 1.
Point of care testing of residual effect of antiplatelet therapy in trauma patients or during major surgery may result in improved clinical management of significant bleeding. We included 121 healthy individuals (57 females and 64 males, aged 22-65 years) in order to establish reference intervals for platelet aggregation induced by adenosine diphosphate (ADPTEM, 10 µM), arachidonic acid (ARATEM, 0.42 mM) and thrombin activating peptide (TRAPTEM, 36 µM) employing the ROTEM platelet module. Further, the impact of citrate (3.2%) and hirudin (>15 µg/ml) as anticoagulants was evaluated. Finally, we investigated assay stability (15, 30, 60, and 120 min after blood sampling) (n = 8) and between-day variation (n = 5). We report reference intervals for 121 healthy individuals and reference intervals by gender. We observed significantly higher platelet aggregation in females than in males (all -values < 0.05). No correlation between age and platelet aggregation was observed, except for the parameter TRAPTEM amplitude (A6), in which a decline in A6 was observed with increasing age ( = 0.03). We observed significantly lower levels of platelet aggregation in citrate tubes than in hirudin tubes (all -values < 0.05), except from TRAPTEM maximum slope, where no significant difference was observed ( = 0.40).The stability was acceptable (≤20% deviation) for up to 120 min for ARATEM in citrate tubes, and up to 60 min for the ADPTEM and TRAPTEM assays in citrate tubes. In hirudin tubes we found ADPTEM and ARATEM assays to be stable for 60 min, while the stability of TRAPTEM in hirudin tubes was found to be stable for 30 min. Using citrate tubes, the between-day variation (mean coefficient of variation, CV) was 19-20% for ADPTEM, 19-26% for TRAPTEM, and 10% for ARATEM, whereas the mean CV was 11-13% for all three assays in hirudin tubes.In conclusion, we established combined and gender-specific reference intervals for three platelet aggregation assays in both citrate- and hirudin tubes. In citrate tubes, the stability of the ROTEM platelet assays was 60-120 min, while the stability in hirudin tubes was 30-60 min. The between-day variation was lowest for samples obtained in hirudin tubes.
在创伤患者或大手术期间进行即时检测抗血小板治疗的残留效果，可能会改善严重出血的临床管理。我们纳入了 121 名健康个体（57 名女性和 64 名男性，年龄 22-65 岁），以建立使用 ROTEM 血小板模块检测由二磷酸腺苷（ADPTE，10μM）、花生四烯酸（ARATE，0.42mM）和凝血酶激活肽（TRAPTE，36μM）诱导的血小板聚集的参考区间。此外，评估了柠檬酸盐（3.2%）和水蛭素（>15μg/ml）作为抗凝剂的影响。最后，我们研究了检测稳定性（采血后 15、30、60 和 120 分钟）（n=8）和日间变异性（n=5）。我们报告了 121 名健康个体的参考区间和按性别划分的参考区间。我们观察到女性的血小板聚集显著高于男性（所有 -值<0.05）。除了参数 TRAPTE 幅度（A6）外，我们没有观察到年龄与血小板聚集之间的相关性，在 A6 中，随着年龄的增加，A6 呈下降趋势（=0.03）。我们观察到柠檬酸盐管中的血小板聚集水平明显低于水蛭素管（所有 -值<0.05），除了 TRAPTE 最大斜率，其中没有观察到显著差异（=0.40）。对于柠檬酸盐管中的 ARATEM，检测稳定性在 120 分钟内可接受（偏差≤20%），对于柠檬酸盐管中的 ADPTEM 和 TRAPTEM 检测，检测稳定性在 60 分钟内可接受。在水蛭素管中，我们发现 ADPTEM 和 ARATEM 检测在 60 分钟内稳定，而在水蛭素管中 TRAPTEM 的稳定性在 30 分钟内稳定。使用柠檬酸盐管，ADPTE、TRAPTEM 的日间变异（平均变异系数，CV）分别为 19-20%和 19-26%，ARATEM 为 10%，而在水蛭素管中，所有三种检测的平均 CV 均为 11-13%。综上所述，我们在柠檬酸盐管和水蛭素管中建立了三种血小板聚集检测的综合和性别特异性参考区间。在柠檬酸盐管中，ROTEM 血小板检测的稳定性为 60-120 分钟，而在水蛭素管中的稳定性为 30-60 分钟。在水蛭素管中获得的样本的日间变异性最低。
