Rijvers Liza, Rijpma Sanna R, van Wetten Herbert B, Henskens Yvonne M C, Stroobants An K
Eurofins Gelre, Eurofins Clinical Diagnostics, Gelre ziekenhuis, Apeldoorn, the Netherlands.
Laboratory of Hematology, Department of Laboratory Medicine, Radboud UMC, Nijmegen, the Netherlands.
Res Pract Thromb Haemost. 2024 Nov 5;8(8):102616. doi: 10.1016/j.rpth.2024.102616. eCollection 2024 Nov.
Surgical procedures in anticoagulated patients require specific attention due to increased bleeding risk. Preoperative anticoagulation interruption in high-risk patients is often necessary. Bridging anticoagulation with low-molecular-weight heparin (LMWH) minimizes thromboembolic risk, but its effect on international normalized ratio (INR) measurement is not well established, necessitating careful monitoring and individual assessment.
To investigate the effect of heparin bridging on INR measurements in anticoagulated patients on vitamin K antagonist (VKA) and in spiking experiments.
Thirty-eight anticoagulated patients on VKA undergoing valve replacement surgery were studied using 2 plasma-based INR assays and 1 whole blood point-of-care INR method at multiple time points after postoperatively resuming VKA. In addition, INR levels in pooled plasma of both normal and VKA-treated individuals were compared, with 7 spiked concentrations of LMWH or unfractionated heparin (UFH) in 4 INR assays.
In LMWH-bridged anticoagulated patients, the INR results obtained with HemosIL RecombiPlasTin and point-of-care Coaguchek were significantly higher than those obtained with STA Hepato Prest within 3 days after restart of VKA. After spiking LMWH or UFH in various concentrations into pooled plasma, only the STA Hepato Prest assay showed no interference in INR measurement within the therapeutic range (1.0-2.0 international units/mL) in both VKA and normal plasma. All other assays showed substantial interference, with the Thromborel S assay being the most heparin-sensitive assay.
Differences between INR methods are seen within 72 hours after restarting VKA in postoperative patients who receive LMWH bridging. experiments using LMWH and UFH show the interference of heparin in multiple INR methods, even with concentrations below the suppliers' stated heparin interference limits.
由于出血风险增加，抗凝患者的外科手术需要特别关注。高危患者术前通常需要中断抗凝。用低分子量肝素（LMWH）进行桥接抗凝可将血栓栓塞风险降至最低，但其对国际标准化比值（INR）测量的影响尚未明确，因此需要仔细监测和个体化评估。
研究肝素桥接对抗凝的维生素K拮抗剂（VKA）患者和加样实验中INR测量的影响。
对38例接受瓣膜置换手术的VKA抗凝患者，在术后恢复VKA后的多个时间点，使用2种基于血浆的INR检测方法和1种全血即时检测INR方法进行研究。此外，比较了正常个体和VKA治疗个体的混合血浆中的INR水平，在4种INR检测方法中加入7种不同浓度的LMWH或普通肝素（UFH）。
在LMWH桥接抗凝的患者中，重新开始使用VKA后3天内，使用HemosIL RecombiPlasTin和即时检测的Coaguchek获得的INR结果显著高于使用STA Hepato Prest获得的结果。在混合血浆中加入不同浓度的LMWH或UFH后，只有STA Hepato Prest检测在VKA和正常血浆的治疗范围内（1.0 - 2.0国际单位/毫升）对INR测量无干扰。所有其他检测均显示出显著干扰，Thromborel S检测是对肝素最敏感的检测方法。
接受LMWH桥接的术后患者重新开始使用VKA后72小时内，INR方法之间存在差异。使用LMWH和UFH的实验表明，即使肝素浓度低于供应商规定的肝素干扰限度，但肝素仍会干扰多种INR方法。
