Blumenthal R S, Carter A J, Resar J R, Coombs V, Gloth S T, Dalal J, Brinker J A
Johns Hopkins University, Baltimore, Maryland, USA.
Cathet Cardiovasc Diagn. 1995 May;35(1):9-17. doi: 10.1002/ccd.1810350104.
The activated clotting time is routinely used to monitor anticoagulation during coronary intervention, whereas the hospital laboratory APTT guides pre- and postprocedure heparin therapy. An optimal coagulation test for patients undergoing percutaneous revascularization would provide a rapid and accurate assessment of anticoagulation throughout a broad range of heparin therapy. We studied the relationships of the bedside whole blood APTT, ACT, and the laboratory APTT in 166 patients undergoing coronary intervation. The whole blood APTT correlated closely with the laboratory APTT (range 18-80 sec) (r = .75), whereas the ACT and laboratory APTT had only a fair correlation (r = .42). Also, the whole blood APTT demonstrated a strong correlation with the ACT throughout the range of heparin therapy for intervention (r = .81). The diagnostic accuracy of the whole blood APTT, based on the receiver operating characteristic curve, was significantly better than that for the ACT in determining the anticoagulation status. The whole blood APTT obtained by bedside monitoring provides a rapid and accurate assessment of anticoagulation throughout the range of heparin dosing associated with coronary intervention. In situations in which an adequate assessment of residual anticoagulation is necessary, the whole blood APTT is superior to the ACT and probably should be the method of choice.
活化凝血时间通常用于监测冠状动脉介入治疗期间的抗凝情况，而医院实验室的活化部分凝血活酶时间（APTT）则指导术前和术后的肝素治疗。对于接受经皮血管重建术的患者，一种理想的凝血试验应能在广泛的肝素治疗范围内快速、准确地评估抗凝效果。我们研究了166例接受冠状动脉介入治疗患者的床旁全血APTT、活化凝血时间（ACT）与实验室APTT之间的关系。全血APTT与实验室APTT（范围为18 - 80秒）密切相关（r = 0.75），而ACT与实验室APTT的相关性一般（r = 0.42）。此外，在整个肝素治疗介入范围内，全血APTT与ACT也呈现出强相关性（r = 0.81）。基于受试者工作特征曲线，全血APTT在确定抗凝状态方面的诊断准确性显著优于ACT。通过床旁监测获得的全血APTT能在与冠状动脉介入相关的肝素给药范围内快速、准确地评估抗凝效果。在需要充分评估残余抗凝情况的情况下，全血APTT优于ACT，可能应作为首选方法。
