Brack M J, More R S, Forbat L N, Hubner P J, Gershlick A H
Academic Department of Cardiology, Glenfield General Hospital, Leicester, UK.
Int J Cardiol. 1994 Jun 15;45(2):103-8. doi: 10.1016/0167-5273(94)90264-x.
We have assessed bedside kits for monitoring the activated partial thromboplastin time and the activated clotting time by comparing them with laboratory activated partial thromboplastin time values. To determine the accuracy of anticoagulation we have concurrently measured the plasma heparin concentrations, and plasma prothrombin fragment F1 + 2 concentrations. Serial samples were taken from patients undergoing elective percutaneous transluminal coronary angioplasty (n = 14). Readings were taken pre-procedure, 30 min after administration of a heparin bolus (10,000 U) and 1, 2 and 3 h after commencement of a constant heparin infusion (15 U/kg/h) postprocedure. Activated partial thromboplastin time results obtained with the bedside kit compared reliably with laboratory values (r = 0.8), were rapidly available and were reflected by appropriate changes in prothrombin fragment F1 + 2 and heparin concentrations. However, the relationship between activated partial thromboplastin time values and activated clotting time was less precise (r = 0.59). Therefore, for routine and frequent monitoring of anticoagulation with heparin, a bedside activated partial thromboplastin time kit provides adequate control of therapy but in instances were particularly tight control of anticoagulation is required, use of prothrombin fragment F1 + 2 concentrations may be more appropriate.
我们通过将床边检测试剂盒所测的活化部分凝血活酶时间（activated partial thromboplastin time，APTT）及活化凝血时间（activated clotting time，ACT）与实验室检测的APTT值进行比较，对这些床边检测试剂盒进行了评估。为确定抗凝的准确性，我们同时测定了血浆肝素浓度及血浆凝血酶原片段F1 + 2浓度。对14例接受择期经皮腔内冠状动脉成形术（percutaneous transluminal coronary angioplasty，PTCA）的患者采集了系列样本。在术前、给予肝素推注（10,000 U）后30分钟以及术后开始持续肝素输注（15 U/kg/h）后1、2和3小时进行读数。床边检测试剂盒所获得的APTT结果与实验室值比较可靠（r = 0.8），结果可快速获得，并且凝血酶原片段F1 + 2和肝素浓度的适当变化也反映了这一结果。然而，APTT值与ACT之间的关系不太精确（r = 0.59）。因此，对于肝素抗凝的常规和频繁监测，床边APTT检测试剂盒可提供充分的治疗控制，但在需要特别严格控制抗凝的情况下，使用凝血酶原片段F1 + 2浓度可能更为合适。
