In vitro neutralization of heparin in plasma prior to the activated partial thromboplastin time test: An assessment of four heparin antagonists and two anion exchange resins

Cumming, A. M.; Jones, Gareth R.; Wensley, R. T.; Cundall, R. B.

doi:10.1016/0049-3848(86)90278-1

Cited by 28 publications

(13 citation statements)

References 24 publications

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“…9 The anticoagulant effect of polybrene on aPTT is much less when the contact-activation process is stimulated before, rather than after, adding polybrene to plasma (Figure 3). Our finding that polybrene shortened the aPTT results at low concentrations but prolonged them at higher concentrations is similar to that in a previous study, 10 in which less than 50 lg/mL polybrene had clot-promoting activity. Polybrene was also found to shorten the clotting time of the functional assay for factor VIIa.…”

Section: The Incidence Of Heparin Contaminationsupporting

confidence: 80%

Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

Tientadakul

Kongkan

Chinswangwatanakul

2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Heparin contamination in blood samples may cause false prolongation of activated partial thromboplastin time (aPTT) and prothrombin time results. Polybrene can neutralize heparin, but it affects coagulation by itself.Objectives.-To determine the optimal concentration of polybrene to neutralize heparin, to determine the suitable sequence of reagents for the neutralization method performed on the analyzer at the same time as prothrombin time and aPTT testing, and to detect the heparin contamination in blood samples for coagulation tests in our hospital using this method.Design.-Various concentrations of heparin were added to 10 normal and 76 abnormal plasma samples to study the efficacy of polybrene. Two programs of reagent sequencing for aPTT with polybrene performed on the analyzer were tested. Samples suspected of heparin contamination according to our criteria were selected for neutralization during a 3-month period.Results.-The optimal final concentration of polybrene was 25 lg/mL. Polybrene should be added after the aPTT reagent to minimize its interference effect. Even though results of prothrombin time and aPTT after neutralization did not equal those before the spike of heparin, the differences might not be clinically significant. Eighty-one of 4921 samples (1.6%) were selected for aPTT with the neutralization method, and the detection rate of heparin contamination was 84% (68 of 81), giving an overall incidence of 1.4% (68 of 4921).Conclusions.-This method is inexpensive and can be performed rapidly with prothrombin time and aPTT on the automated analyzer, which makes it easy to practice with no need for extra plasma volumes.

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Section: The Incidence Of Heparin Contaminationsupporting

confidence: 80%

Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

Tientadakul

Kongkan

Chinswangwatanakul

2013

Archives of Pathology &Amp; Laboratory Medicine

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“…Therapeutic anticoagulation inevitably compromises many coagulation assays that are designed to detect a specific abnormality based on the assumption that the patient's coagulation is otherwise normal. Use of heparin neutralisers and mixing studies are available to counteract these effects but they are not without their limitations and accurate detection may not be possible [ 4 , 8 , 12 ]. Whilst it is rarely necessary to investigate for LA in heparinised patients it is relatively often required in those who are receiving OAT [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Combining Taipan snake venom time/Ecarin time screening with the mixing studies of conventional assays increases detection rates of lupus anticoagulants in orally anticoagulated patients

Moore

2007

Thrombosis J

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Background: Oral anticoagulation compromises conventional lupus anticoagulant (LA) screening assays. Mixing studies can counteract the oral anticoagulant effect but the dilution reduces sensitivity and can generate false negative results. A firm diagnosis can be made from mixing studies when an elevated screen ratio is accompanied by a confirm ratio that generates significant correction to demonstrate phospholipid dependence, but also returns into the reference range, indicating complete normalisation of the oral anticoagulant effect. Taipan snake venom time (TSVT) with Ecarin time (ET) as a confirmatory test comprises an oral anticoagulant insensitive LA detection system and this study investigates the potential impact on detection rates when coupled with mixing studies on standard assays.

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“…Several methods for removal of heparin from plasma have been described that involve absorption of heparin by cellulose resin (Cumming et al, 1986;Wenz & Burns, 1991), affinity filtration (Wenz & Burns, 1991) or enzymatic elimination (Hutt & Kingdom, 1972). Some heparin elimination techniques can lead to reduction of clotting factors, particularly factor IX, which was reduced to about 60% of initial levels by cellulose resin adsorption and to 70% by affinity filtration in one study (Wenz & Burns, 1991).…”

mentioning

confidence: 99%

Problems In Laboratory Monitoring Of Heparin Dosage

Kitchen

2000

Br J Haematol

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In vitro neutralization of heparin in plasma prior to the activated partial thromboplastin time test: An assessment of four heparin antagonists and two anion exchange resins

Cited by 28 publications

References 24 publications

Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

Use of an Automated Coagulation Analyzer to Perform Heparin Neutralization With Polybrene in Blood Samples for Routine Coagulation Testing: Practical, Rapid, and Inexpensive

Combining Taipan snake venom time/Ecarin time screening with the mixing studies of conventional assays increases detection rates of lupus anticoagulants in orally anticoagulated patients

Problems In Laboratory Monitoring Of Heparin Dosage

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