Preservation of in vitro function of platelets stored in the presence of a synthetic dual inhibitor of factor Xa and thrombin.
BACKGROUND
The use of citrate anticoagulant limits the clinical significance of platelet function tests. Thrombin inhibitors cannot prevent thrombin-induced platelet activation completely. We examined the influence of benzylsulfonyl-d-Arg-Pro-4-amidinobenzylamide (BAPA), a dual inhibitor of Factor Xa (FXa) and thrombin, on platelet responsiveness to agonists when measured between 2 and 24 h after venipuncture.


METHODS
Blood samples from 36 individuals were anticoagulated with citrate and BAPA, respectively. Turbidimetric platelet aggregometry (TPA) and impedance platelet aggregometry (IPA), a whole blood platelet counting assay for measuring platelet aggregation (PCA), and Platelet Function Anlayzer-100 (PFA-100 closure times (CTs) were determined after whole blood storage between 2 and 24 h after venipuncture. Native whole blood was studied over 48 h to determine the inhibition of thrombin generation by BAPA, hirudin and melagatran.


RESULTS
BAPA inhibited thrombin generation completely for 48 h, while hirudin and melagatran did not. The use of citrate resulted in significantly reduced TPA induced by arachidonic acid (AA) or adenosine 5'-diphosphate (ADP), and significantly reduced IPA regardless of agonist when measured 10 and 24 h after blood collection. PCA ratios in citrated blood also dropped significantly 10 and 24 h after venipuncture. The length of storage of BAPA-anticoagulated blood samples over 24 h had no significant influence on any platelet response. The reproducibility of platelet function assay results obtained from BAPA-anticoagulated samples was significantly better than corresponding data from citrated blood.


CONCLUSIONS
TPA, IPA, PCA or PFA-100 CTs remain stable for 24 h when whole blood is anticoagulated with a dual inhibitor of FXa and thrombin. This would greatly simplify the shipment of samples for platelet function testing.
Institute of Hemostaseology and Transfusion Medicine, Academic City Hospital, Ludwigshafen, Germany. peterhellstern@medicusnet.de
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Hellstern
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Stürzebecher
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Wuchold
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Haubelt
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Seyfert
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Bauer
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Vogt
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Stürzebecher
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000737:chemistry; D001792:Blood Platelets / Q000378:metabolism*; D001793:Blood Preservation / Q000295:instrumentation*; D065427:Factor Xa Inhibitors; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation; D010979:Platelet Function Tests; D015203:Reproducibility of Results; D013048:Specimen Handling; D013917:Thrombin / Q000037:antagonists & inhibitors* / Q000737:chemistry
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D013917:Thrombin