title: Differential effects of unfractionated heparin and low-molecular-weight heparins on tissue thromboplastin inhibition test.
abstract: Circulating anticoagulants are endogenously produced substances that interfere with in vitro tests of coagulation like activated partial thromboplastin time (APTT), and cause prolongation of the clotting times. Evaluation of the abnormal APTT involving various factor assays and mixing studies may provide inconclusive and ambiguous results. Tissue thromboplastin inhibition test (TTIT) is one of the screening assays for detection of circulating anticoagulants. However, this test is influenced by the presence of unfractionated heparin (UFH) from concentrations 0.2 U/mL and higher. Since low-molecular-weight heparins (LMWHs) are increasingly used for the prevention of thrombotic disorders and may replace UFH in the future, in this study the authors studied the influence of LMWHs on the performance of TTIT and compared the results with UFH. UFH and LMWHs showed a prolongation of TTIT in the concentration range of 0.25-1.0 U/mL. The marked prolongation of the TTIT with UFH and different LMWHs is in decreasing order of UFH > ardeparin > tinzaparin > dalteparin > enoxaparin. Patients with circulating anticoagulants who are given LMWHs may have false-positive results of TTIT and this influence should be kept in mind during patient management.
authors.affiliation: Department of Hematology, Kaunas Medical University, Lithuania.
authors.forename: R
authors.initials: R
authors.lastname: Gerbutavicius
authors.forename: O
authors.initials: O
authors.lastname: Iqbal
authors.forename: H
authors.initials: H
authors.lastname: Messmore
authors.forename: D A
authors.initials: DA
authors.lastname: Hoppensteadt
authors.forename: M
authors.initials: M
authors.lastname: Demir
authors.forename: E
authors.initials: E
authors.lastname: Khan
authors.forename: P
authors.initials: P
authors.lastname: Bacher
authors.forename: J
authors.initials: J
authors.lastname: Fareed
mesh_terms: D000925:Anticoagulants / Q000097:blood / Q000494:pharmacology; D001780:Blood Coagulation Tests / Q000379:methods / Q000592:standards; D004305:Dose-Response Relationship, Drug; D005189:False Positive Reactions; D006493:Heparin / Q000097:blood / Q000494:pharmacology*; D006495:Heparin, Low-Molecular-Weight / Q000097:blood / Q000494:pharmacology; D006801:Humans; D013925:Thromboplastin / Q000037:antagonists & inhibitors* / Q000187:drug effects
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D013925:Thromboplastin