The danger of relying on the APTT and PT in patients on DOAC therapy, a potential patient safety issue

被引：33

作者：

Adcock, D. M. ^{[1
]}

Gosselin, R. C. ^{[2
]}

机构：

[1] Colorado Coagulat, Lab Corp Amer Holdings, Englewood, CO USA

[2] Univ Calif Davis, Davis, CA 95616 USA

来源：

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY | 2017年 / 39卷

关键词：

activated partial thromboplastin time; direct oral anticoagulants; prothrombin time; risk; safety; FACTOR XA; COAGULATION TESTS; RIVAROXABAN; WARFARIN; PERFORMANCE; DABIGATRAN; APIXABAN; THROMBIN; EDOXABAN; ASSAYS;

D O I：

10.1111/ijlh.12658

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Prolongation of the activated partial thromboplastin time (APTT) and prothrombin time/international normalized ratio (PT/INR) correlates poorly with plasma concentrations of direct oral anticoagulant agents (DOACS) including direct thrombin and direct Xa inhibitors. It has been repeatedly demonstrated that patients can have normal APTT and PT/INR with a therapeutic plasma concentration of a DOAC. Clinicians can no longer rely on a normal APTT and PT to determine that an anticoagulated patient is safe to undergo an invasive procedure. Laboratory scientists need to play a key and active role in educating clinicians about the limitations of the APTT and PT in patients on DOAC prophylaxis or therapy.

引用

页码：37 / 40

页数：4

共 20 条

[1]

Adcock D., 2005, CLSI document H54-A

[2] Direct Oral Anticoagulants (DOACs) in the Laboratory: 2015 Review [J].

Adcock, D. M. ;

Gosselin, R. .

THROMBOSIS RESEARCH, 2015, 136 (01) :7-12

[3] The measurement and application of thrombin generation [J].

Baglin, T .

BRITISH JOURNAL OF HAEMATOLOGY, 2005, 130 (05) :653-661

[4] National Trends in Ambulatory Oral Anticoagulant Use [J].

Barnes, Geoffrey D. ;

Lucas, Eleanor ;

Alexander, G. Caleb ;

Goldberger, Zachary D. .

AMERICAN JOURNAL OF MEDICINE, 2015, 128 (12) :1300-+

[5] Dabigatran versus Warfarin in Patients with Atrial Fibrillation. [J].

Connolly, Stuart J. ;

Ezekowitz, Michael D. ;

Yusuf, Salim ;

Eikelboom, John ;

Oldgren, Jonas ;

Parekh, Amit ;

Pogue, Janice ;

Reilly, Paul A. ;

Themeles, Ellison ;

Varrone, Jeanne ;

Wang, Susan ;

Alings, Marco ;

Xavier, Denis ;

Zhu, Jun ;

Diaz, Rafael ;

Lewis, Basil S. ;

Darius, Harald ;

Diener, Hans-Christoph ;

Joyner, Campbell D. ;

Wallentin, Lars .

NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (12) :1139-1151

[6] Performance of coagulation tests in patients on therapeutic doses of rivaroxaban A cross-sectional pharmacodynamic study based on peak and trough plasma levels [J].

Francart, Suzanne J. ;

Hawes, Emily M. ;

Deal, Allison M. ;

Adcock, Dorothy M. ;

Gosselin, Robert ;

Jeanneret, Cheryl ;

Friedman, Kenneth D. ;

Moll, Stephan .

THROMBOSIS AND HAEMOSTASIS, 2014, 111 (06) :1133-1140

[7] Edoxaban versus Warfarin in Patients with Atrial Fibrillation [J].

Giugliano, Robert P. ;

Ruff, Christian T. ;

Braunwald, Eugene ;

Murphy, Sabina A. ;

Wiviott, Stephen D. ;

Halperin, Jonathan L. ;

Waldo, Albert L. ;

Ezekowitz, Michael D. ;

Weitz, Jeffrey I. ;

Spinar, Jindrich ;

Ruzyllo, Witold ;

Ruda, Mikhail ;

Koretsune, Yukihiro ;

Betcher, Joshua ;

Shi, Minggao ;

Grip, Laura T. ;

Patel, Shirali P. ;

Patel, Indravadan ;

Hanyok, James J. ;

Mercuri, Michele ;

Vogelmann, O. ;

Gonzalez, C. ;

Ahuad Guerrero, R. ;

Rodriguez, M. ;

Albisu, J. ;

Rosales, E. ;

Allall, O. ;

Reguero, M. ;

Alvarez, C. ;

Garcia, M. ;

Ameriso, S. ;

Ameriso, P. ;

Amuchastegui, M. ;

Caceres, M. ;

Beloscar, J. ;

Petrucci, J. ;

Berli, M. ;

Budassi, N. ;

Valle, M. ;

Bustamante Labarta, G. ;

Saravia, M. ;

Caccavo, A. ;

Fracaro, V. ;

Cartasegna, L. ;

Novas, V. ;

Caruso, O. ;

Saa Zarandon, R. ;

Colombo, H. ;

Morandini, M. ;

Cuello, J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2013, 369 (22) :2093-2104

[8] Comparison of the effect of the anti-Xa direct oral anticoagulants apixaban, edoxaban, and rivaroxaban on coagulation assays [J].

Gosselin, R. ;

Grant, R. P. ;

Adcock, D. M. .

INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, 2016, 38 (05) :505-513

[9] Apixaban versus Warfarin in Patients with Atrial Fibrillation [J].

Granger, Christopher B. ;

Alexander, John H. ;

McMurray, John J. V. ;

Lopes, Renato D. ;

Hylek, Elaine M. ;

Hanna, Michael ;

Al-Khalidi, Hussein R. ;

Ansell, Jack ;

Atar, Dan ;

Avezum, Alvaro ;

Cecilia Bahit, M. ;

Diaz, Rafael ;

Easton, J. Donald ;

Ezekowitz, Justin A. ;

Flaker, Greg ;

Garcia, David ;

Geraldes, Margarida ;

Gersh, Bernard J. ;

Golitsyn, Sergey ;

Goto, Shinya ;

Hermosillo, Antonio G. ;

Hohnloser, Stefan H. ;

Horowitz, John ;

Mohan, Puneet ;

Jansky, Petr ;

Lewis, Basil S. ;

Luis Lopez-Sendon, Jose ;

Pais, Prem ;

Parkhomenko, Alexander ;

Verheugt, Freek W. A. ;

Zhu, Jun ;

Wallentin, Lars .

NEW ENGLAND JOURNAL OF MEDICINE, 2011, 365 (11) :981-992

[10] Facts and artefacts of coagulation assays for factor Xa inhibitors [J].

Haas, Sylvia .

THROMBOSIS AND HAEMOSTASIS, 2010, 103 (04) :686-688

← 1 2 →