title: The PiCT®test is a reliable alternative to the activated partial thromboplastin time in unfractionated heparin therapy management: results from a multicenter study.
abstract: Essentials Activated partial thromboplastin time (APTT) or anti-Xa tests are used to monitor heparin. Prothrombinase-induced Clotting Time (PiCT) was compared to APTT in a clinical study. PiCT shows higher correlation to anti-Xa than APTT does and is more comparable between centers. PiCT demonstrates significantly higher accuracy and reliability than APTT in heparin monitoring.
  
  
  
  Background Unfractionated heparin (UFH) is still a commonly used anticoagulant for prevention and treatment of thromboembolism in a variety of situations. Increasingly, chromogenic anti-Xa assays are used for UFH monitoring given the high variability of the activated partial thromboplastin time (APTT) in this setting. On the other hand, and despite the known variability, the APTT test remains the most frequently used monitoring tool in UFH therapy because of its broad availability, lower costs and wide acceptance. Various guidelines continue to recommend the use of the APTT as an anti-Xa surrogate, but this approach remains controversial. Objective To assess the prothrombinase-induced clotting time (PiCT®) test, reported in seconds, as an alternative to the APTT in the management of UFH-mediated anticoagulation. Methods Plasma samples from patients receiving UFH were obtained in three different centers in the USA and Europe. Samples were analyzed for PiCT, APTT and anti-Xa activities with conditions set to allow comparability. Target-ranges in seconds for PiCT and APTT were established for a UFH concentration of 0.3-0.7 IU mL-1, derived from anti-Xa results as suggested by the ACCP guidelines. Results PiCT demonstrated better correlation with anti-Xa IU mL-1than APTT, higher ability to identify samples within target range and, importantly, comparable target-ranges between different centers. Conclusion Accuracy and reliability of PiCT are significantly better than those of APTT in monitoring UFH for anticoagulant therapy.
authors: DSM Pentapharm, Aesch, Switzerland.
authors: A C
authors: 0000-0003-1456-2306
authors: AC
authors: Brisset
authors: DSM Pentapharm, Aesch, Switzerland.
authors: A
authors: A
authors: Ferrández
authors: Deutsche Klinik für Diagnostik GmbH, Wiesbaden, Hessen, Germany.
authors: M
authors: M
authors: Krause
authors: University of Oklahoma Health Sciences Center 920 Stanton L Young, Oklahoma City, OK, USA.
authors: S
authors: S
authors: Rathbun
authors: University of Oklahoma Health Sciences Center 920 Stanton L Young, Oklahoma City, OK, USA.
authors: R
authors: R
authors: Marlar
authors: Center for Laboratory Medicine, Haemostasis and Hemophilia Center St Gallen, St Gallen, Switzerland.
authors: W
authors: W
authors: Korte
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests / Q000379:methods*; D016903:Drug Monitoring / Q000379:methods; D005060:Europe; D015951:Factor Xa / Q000737:chemistry / Q000494:pharmacology; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010314:Partial Thromboplastin Time; D012044:Regression Analysis; D015203:Reproducibility of Results; D013925:Thromboplastin / Q000494:pharmacology*; D013997:Time Factors; D014481:United States
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006490:Hemostatics; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D013925:Thromboplastin; D015951:Factor Xa
keywords: activated partial thromboplastin time; blood coagulation tests; clinical trial; diagnostic; reagent kits; unfractionated heparin