[茶碱腺苷双嘧达莫（CTAD）与柠檬酸盐评估用于监测普通肝素治疗：抗Xa测定的延迟离心验证？]

[Theophylline adenosine dipyridamole (CTAD) and citrate evaluation to survey unfractionated heparin treatment: a delayed centrifugation validation for anti-Xa measurement?].

作者信息

Billoir Paul, Clavier Thomas, Guilbert Arnaud, Barbay Virginie, Chrétien Marie Hélène, Fresel Marielle, Abriou Caroline, Girault Christophe, Le Cam Duchez Véronique

机构信息

Service d'hématologie biologique, CHU Charles Nicolle, Rouen, France, Inserm U1096, CHU Charles Nicolle, Rouen, France.

Département d'anesthésie-réanimation, Inserm U1096, CHU Charles Nicolle, Rouen, France, Inserm U1096, CHU Charles Nicolle, Rouen, France.

出版信息

Ann Biol Clin (Paris). 2020 Feb 1;78(1):27-34. doi: 10.1684/abc.2020.1525.

DOI:10.1684/abc.2020.1525

PMID:32108577

Abstract

UNLABELLED

Unfractionated heparin (UFH) is the main anticoagulante used in intensive care unit. The anticoagulant effect is monitored by activated partial thrombin time (aPTT) and anti-Xa activity (anti-Xa) measurement. However, delayed centrifugation induces platelet factor 4 (PF4) release and anti-Xa decrease. Several studies have concluded that aPTT and anti-Xa measurement should be performed within 2 hours in citrated anticoagulant but may be delayed longer in citrate theophylline adenosine and dypiridamol (CTAD) anticoagulant. The objective of this study was to compare the stability of both aPTT and anti-Xa in citrate and CTAD samples, and to determine the effect of delayed centrifugation on both aPTT, anti-Xa results, and PF4 release in citrate samples only.

METHODS

aPTT and anti-Xa were measured in citrate and CTAD anticoagulant samples from 93 patients. Delayed centrifugation was performed in citrate samples from 31 additional patients, with hourly aPTT and anti-Xa measurement from 1 to 6 hours. In 14 of these last patients, PF4 release was also evaluated with Human CXCL4/PF4 Quantikine ELISA Kit.

RESULTS

We observed a significant correlation between citrate and CTAD anticoagulant for aPTT (r=0.94) and anti-Xa (r=0.95). With Bland-Altman correlation, a minor bias was observed for anti-Xa (-0.025±0.041). Delayed centrifugation in citrated anticoagulant showed an excellent concordance from 1 to 4 hours for aPTT (-4.0±5.3 s) and anti-Xa (1.10±0.058 UI/mL) measurements. Moreover, PF4 release was not different between 1 hour (31.5±14.7 ng/mL) and 4 hours (33.8±11.8 ng/mL).

CONCLUSION

We have demonstrated that anti-Xa measurement for unfractionated heparin should be done 4 hours in citrated plasma and that CTAD was not better than citrate. However, these initial findings require confirmation using other aPTT and calibrated anti-Xa assays.

摘要

未标注

普通肝素（UFH）是重症监护病房使用的主要抗凝剂。通过活化部分凝血活酶时间（aPTT）和抗Xa活性（抗Xa）测量来监测抗凝效果。然而，延迟离心会导致血小板因子4（PF4）释放和抗Xa降低。多项研究得出结论，在枸橼酸盐抗凝剂中，aPTT和抗Xa测量应在2小时内进行，但在枸橼酸盐-茶碱-腺苷-双嘧达莫（CTAD）抗凝剂中可能延迟更长时间。本研究的目的是比较枸橼酸盐和CTAD样本中aPTT和抗Xa的稳定性，并仅确定延迟离心对枸橼酸盐样本中aPTT、抗Xa结果和PF4释放的影响。

方法

对93例患者的枸橼酸盐和CTAD抗凝样本进行aPTT和抗Xa测量。对另外31例患者的枸橼酸盐样本进行延迟离心，从1至6小时每小时测量一次aPTT和抗Xa。在这最后14例患者中，还使用人CXCL4/PF4 Quantikine ELISA试剂盒评估PF4释放。

结果

我们观察到枸橼酸盐和CTAD抗凝剂之间aPTT（r = 0.94）和抗Xa（r = 0.95）存在显著相关性。通过Bland-Altman相关性分析，观察到抗Xa存在轻微偏差（-0.025±0.041）。枸橼酸盐抗凝剂中的延迟离心显示，aPTT（-4.0±5.3秒）和抗Xa（1.10±0.058 UI/mL）测量在1至4小时内具有良好的一致性。此外，1小时（31.5±14.7 ng/mL）和4小时（33.8±11.8 ng/mL）之间的PF4释放没有差异。