Point of care measurement of lepirudin and heparin anticoagulation during systemic inflammation.
BACKGROUND
The number of indications for recombinant human hirudin lepirudin therapy has increased in recent years, and now includes acute coronary syndromes and heparin-induced thrombocytopenia. Hence, point of care monitoring appears desirable for therapy with lepirudin. As CoaguChek Plus (CCP) provides a rapid bedside test to monitor therapy with other anticoagulants, we aimed to determine its suitability for lepirudin therapy.


METHODS
Forty-four healthy volunteers received a 2 ng/kg endotoxin infusion (to induce coagulation) together with clinically relevant doses of lepirudin or heparin in a prospective, placebo-controlled, randomised fashion. Measurements of CCP-partial thromboplastin time (aPTT) were compared to laboratory STA-aPTT.


RESULTS
As expected, baseline values of CCP-aPTT were shorter than STA-aPTT. Lepirudin increased CCP-aPTT 3-fold, and STA-aPTT 2-fold 1 h after bolus infusion. During lepirudin infusion, the correlation between CCP-aPTT and STA-aPTT was excellent (r=0.86-0.92). Both methods were equally sensitive to over-anticoagulation with heparin. Acute systemic inflammation had little effects on CCP-aPTT.


CONCLUSIONS
CCP-aPTT is suitable for longitudinal point of care monitoring of lepirudin therapy. As baseline values of CCP-aPTT are shorter than STA-aPTT, it is recommended not to indiscriminately change between methods in the follow-up of individual patients.
Homoncik
Monika
M
Department of Clinical Pharmacology, Division of Immunology and Haematology, Vienna University School of Medicine, Währinger Gürtel 18-20, A-1090 Wien, Austria.
Pernerstorfer
Thomas
T
Reiter
Rosemarie
R
Knechtelsdorfer
Maarten
M
Quehenberger
Peter
P
Jilma
Bernd
B
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests / Q000379:methods / Q000706:statistics & numerical data; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000188:drug therapy*; D008070:Lipopolysaccharides / Q000008:administration & dosage; D008297:Male; D010314:Partial Thromboplastin Time; D019095:Point-of-Care Systems / Q000706:statistics & numerical data; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012680:Sensitivity and Specificity
D000925:Anticoagulants; D006629:Hirudins; D008070:Lipopolysaccharides; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin