title: Point of care measurement of lepirudin and heparin anticoagulation during systemic inflammation.
abstract: 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.
authors.affiliation: Department of Clinical Pharmacology, Division of Immunology and Haematology, Vienna University School of Medicine, Währinger Gürtel 18-20, A-1090 Wien, Austria.
authors.forename: Monika
authors.initials: M
authors.lastname: Homoncik
authors.forename: Thomas
authors.initials: T
authors.lastname: Pernerstorfer
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Reiter
authors.forename: Maarten
authors.initials: M
authors.lastname: Knechtelsdorfer
authors.forename: Peter
authors.initials: P
authors.lastname: Quehenberger
authors.forename: Bernd
authors.initials: B
authors.lastname: Jilma
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D008070:Lipopolysaccharides; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin