Response of the Activated Partial Thromboplastin Time (APTT) to Heparin Is Influenced by Coagulometers

Besselaar, A. M. H. P. Van Den; Meeuwisse-Braun, J.; Strebus, A.; Mansfeld, H. Schaefer-Van; Witteveen, E.; Meer, F. J. M. Van Der

doi:10.1055/s-0038-1649948

Cited by 10 publications

(1 citation statement)

References 4 publications

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“…However, several variables can affect the measurement of aPTT (Figure 2), which is also prolonged by any deficiency of the intrinsic (contact) pathway (eg, deficiencies of factors XII, XI, and IX) and common coagulation pathway (eg, deficiencies of factors V, X, II, or fibrinogen) and in the presence of inhibitors. Measurement techniques may also influence aPTT; for example, reagents with different sensitivities are available, and deviation from manufacturer recommended incubation times or the use of different coagulometers can affect clotting times 27,28 …”

Section: Diagnostic Pathways In Hemophiliamentioning

confidence: 99%

Laboratory testing in hemophilia: Impact of factor and non‐factor replacement therapy on coagulation assays

Peyvandi

Kenet

Pekrul³

et al. 2020

Journal of Thrombosis and Haemostasis

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The advent of extended half‐life (EHL) recombinant clotting factors and innovative non‐factor replacement therapeutics, such as emicizumab, offers several advantages over existing products for the prophylactic treatment of people living with hemophilia (PwH). These include low annual bleeding rates with less frequent dosing, higher trough plasma concentrations, and a more convenient route of administration. However, increasing use of these therapies poses challenges to clinicians and coagulation laboratories due to the lack of standardized assays for monitoring of hemostatic parameters, and the potential for misinterpretation of test results, which may jeopardize patient safety. Definitive diagnosis of hemophilia and treatment monitoring is reliant on demonstrating factor VIII (FVIII; hemophilia A) or factor IX (FIX; hemophilia B) deficiency using a functional coagulation assay. The most frequently used assays are based on activated partial thromboplastin time, using a one‐stage or two‐stage process. While one‐stage and chromogenic assays have performed well with human‐derived FVIII and FIX and full‐length recombinant products, EHL recombinant factors are heterogeneous in structure and mode of action and therefore show wide variation in activity levels between different one‐stage assays, and between one‐stage and chromogenic assays. In the context of the recommended stepwise approach for laboratory diagnosis of hemophilia, we examine the diagnostic challenges associated with the use of EHL factors and novel non‐factor therapeutics and consider the optimal diagnostic approach in PwH who are receiving these treatments. Ultimately, accurate diagnostic solutions are a prerequisite for personalized therapy to minimize treatment burden and improve quality of life in PwH.

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Section: Diagnostic Pathways In Hemophiliamentioning

confidence: 99%

Laboratory testing in hemophilia: Impact of factor and non‐factor replacement therapy on coagulation assays

Peyvandi

Kenet

Pekrul³

et al. 2020

Journal of Thrombosis and Haemostasis

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Thrombodynamics, a new global coagulation test: Measurement of heparin efficiency

Sinauridze

Vuimo

Tarandovskiy

et al. 2018

Talanta

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The actual coagulation status may be reliably measured using only highly sensitive global functional tests; however, they are not numerous and all of them have disadvantages. Thrombodynamics (TD), a novel global coagulation test, is sensitive to hypo- and hypercoagulable states. The main properties of this test were investigated, and its capabilities for hemostasis analysis were verified through pharmacodynamic monitoring of the most widely used anticoagulants, heparins. The anticoagulant effects in the plasma of donors (n = 20) and patients after hip replacement (n = 20) spiked with unfractionated heparin or enoxaparin were measured in vitro to eliminate the influence of pharmacokinetic factors. Sensitivity for heparins was compared for activated partial thromboplastin time, thrombin generation tests and TD. TD was shown to reliably characterize the pharmacodynamics of any heparin in the entire range of its prophylactic and therapeutic concentrations. Inter-individual variability for the anticoagulant action of heparins was also calculated using the TD data. This variability did not differ between the investigated groups and did not exceed 12% and 20% for the stationary clot growth rate in the presence of unfractionated heparin and enoxaparin, respectively. That finding was in accordance with the values determined earlier using the thrombin generation test. The study results showed that TD has advantages over the other global methods of coagulation analysis. These advantages are good standardization, high reproducibility, independence of the parameter values from patient age and gender, and a narrower parameter distribution in a normal population. These results indicate that TD is a promising universal assessment method that improves the quality of hemostasis analysis because it more reliably detects deviations from the parameters' reference values.

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Monitoring of unfractionated heparin with the activated partial thromboplastin time: determination of therapeutic ranges

Besselaar¹,

Sturk²,

Reijnierse³

2002

Thrombosis Research

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Response of the Activated Partial Thromboplastin Time (APTT) to Heparin Is Influenced by Coagulometers

Cited by 10 publications

References 4 publications

Laboratory testing in hemophilia: Impact of factor and non‐factor replacement therapy on coagulation assays

Laboratory testing in hemophilia: Impact of factor and non‐factor replacement therapy on coagulation assays

Thrombodynamics, a new global coagulation test: Measurement of heparin efficiency

Monitoring of unfractionated heparin with the activated partial thromboplastin time: determination of therapeutic ranges

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