The uncalibrated prothrombinase-induced clotting time test. Equally convenient but more precise than the aPTT for monitoring of unfractionated heparin.
The activated partial thromboplastin time test (aPTT) represents one of the most commonly used diagnostic tools in order to monitor patients undergoing heparin therapy. Expression of aPTT coagulation time in seconds represents common practice in order to evaluate the integrity of the coagulation cascade. The prolongation of the aPTT thus can indicate whether or not the heparin level is likely to be within therapeutic range. Unfortunately aPTT results are highly variable depending on patient properties, manufacturer, different reagents and instruments among others but most importantly aPTT's dose response curve to heparin often lacks linearity. Furthermore, aPTT assays are insensitive to drugs such as, for example, low molecular weight heparin (LMWH) and direct factor Xa (FXa) inhibitors among others. On the other hand, the protrombinase-induced clotting time assay (PiCT®) has been show to be a reliable functional assay sensitive to all heparinoids as well as direct thrombin inhibitors (DTIs). So far, the commercially available PiCT assay (Pefakit®PiCT®, DSM Nutritional Products Ltd. Branch Pentapharm, Basel, Switzerland) is designed to express results in terms of units with the help of specific calibrators, while aPTT results are most commonly expressed as coagulation time in seconds. In this report, we describe the results of a pilot study indicating that the Pefakit PiCT UC assay is superior to the aPTT for the efficient monitoring of patients undergoing UFH therapy; it is also suitable to determine and quantitate the effect of LMWH therapy. This indicates a distinct benefit when using this new approach over the use of aPPT for heparin monitoring.
Institut für Klinische Chemie und HämatologieFrohbergstr. 3, 9001 St. Gallen, Switzerland. Wolfgang.Korte@ikch.ch
W
W
Korte
R
R
Jovic
M
M
Hollenstein
P
P
Degiacomi
M
M
Gautschi
A
A
Ferrández
D001777:Blood Coagulation; D004305:Dose-Response Relationship, Drug; D006493:Heparin / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D007700:Kinetics; D008991:Monitoring, Physiologic / Q000379:methods; D010314:Partial Thromboplastin Time; D013925:Thromboplastin / Q000378:metabolism*
D006493:Heparin; D013925:Thromboplastin