title: Ecarin modified rotational thrombelastometry: a point-of-care applicable alternative to monitor the direct thrombin inhibitor argatroban.
abstract: OBJECTIVE
  Adequate monitoring of the effect of the direct thrombin inhibitor argatroban may facilitate individualized dosing and perioperative management of anticoagulation. Ecarin Clotting Time is proposed for this purpose, but has the major disadvantage of limited availability. There is a point-of-care applicable ecarin-activated test modification for rotational thrombelastometry (ROTEM®) which is sensitive to direct thrombin inhibitors. The aim of the study was to evaluate the correlation between argatroban concentration and this ecarin modified thrombelastometry (EMT).
  
  
  METHODS
  In this in vitro experiment, blood drawn from healthy volunteers was spiked with argatroban at clinically relevant concentrations and analyzed with ROTEM® using EMT. The main endpoint was the clotting time (CT).
  
  
  RESULTS
  EMT-CT was prolonged with increasing argatroban concentrations (from 83.3 ± 6.7 s without argatroban to 743.5 ± 138.2 s at 2 μg/ml argatroban). The correlation between argatroban concentration and EMT-CT was high (r = 0.94) and statistically significant (p < 0.01).
  
  
  CONCLUSIONS
  These promising preclinical results mandate further clinical research to determine an EMT-CT target range regarding the clinical outcomes of thrombosis and bleeding.
authors: Department of Anaesthesiology, General Intensive Care and Pain Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. eva.schaden@meduniwien.ac.at
authors: Eva
authors: E
authors: Schaden
authors: Andreas
authors: A
authors: Schober
authors: Stefan
authors: S
authors: Hacker
authors: Sibylle
authors: S
authors: Kozek-Langenecker
mesh_terms: D000991:Antithrombins / Q000494:pharmacology; D001120:Arginine / Q000031:analogs & derivatives; D001777:Blood Coagulation / Q000187:drug effects*; D016903:Drug Monitoring / Q000379:methods*; D010450:Endopeptidases / Q000494:pharmacology; D005343:Fibrinolytic Agents / Q000494:pharmacology; D006801:Humans; D010875:Pipecolic Acids / Q000494:pharmacology*; D019095:Point-of-Care Systems; D013449:Sulfonamides; D013916:Thrombelastography / Q000379:methods*
chemical_list: D000991:Antithrombins; D005343:Fibrinolytic Agents; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; D010450:Endopeptidases; C020097:ecarin; C031942:argatroban