[Role of laboratory monitoring in oral anticoagulant therapy].
The aim of oral anticoagulant therapy is to administer an amount of drug such that, without the induction of severe hemorrhagic complications, thrombi will not develop, or any existing thrombus will stop growing and resolve. For the laboratory control of oral anticoagulant therapy, the prothrombin time is used universally as the primary measurement. The expression of the prothrombin time as "percentage coagulation activity" or "ratio" is not useful as international measures of oral anticoagulant intensity because they are thromboplastin dependent. With the conversion of the "ratio" in International Normalized Ratio, at present it is possible to give a universal measure of oral anticoagulant intensity. It is important to underline that the application of the International Normalized Ratio to situations other than oral anticoagulant monitoring is not useful. Moreover there are other important factors contributing to the imprecision of the International Normalized Ratio: the imprecision of the International Sensitivity Index, the biological variation of the International Normalized Ratio. New approaches to oral anticoagulant therapy and its management are being explored. Immunologic assays have been developed with potential responsiveness to minimal warfarin-induced anticoagulant effects. Use of antibody reagents are in progress to document the clinical usefulness of the methods for monitoring oral anticoagulant therapy.
D'Angelo
G
G
Ospedale A. Bellini, Somma Lombardo, Varese, Regione Lombardia.
Calvano
D
D
Giardini
C
C
D000284:Administration, Oral; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D011517:Prothrombin Time; D012016:Reference Values; D013927:Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants
Ruolo del laboratorio nel monitoraggio della terapia con anticoagulanti orali.