French Multicentric Evaluation of Recombinant Tissue Factor (Recombiplastin) for Determination of Prothrombin Time

1994 ◽  
Vol 72 (05) ◽  
pp. 698-704 ◽  
Author(s):  
J Roussi ◽  
L Drouet ◽  
M Samama ◽  
P Sié ◽  
C Bal ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Tissue Factor ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
The Other ◽  
University Hospital ◽  
Factor Vii ◽  
Sensitivity Index ◽  
Diagnostic Systems ◽  
Multicentric Study

SummaryRecombiplastin, a recombinant a human tissue factor, elaborated by Ortho Diagnostic Systems, produced by Baculovirus and relipidated with highly purified phospholipids, was tested as a new reagent for determining prothrombin time (PT) in a French multicentric study. Its intralaboratory- performances, including sensitivity, repeatability, reproducibility and stability, were explored to establish whether its use would reduce the interlaboratory dispersion of PT values, and therefore improve the standardization of oral anticoagulant treatment.The 9 university hospital hematology laboratories involved in this study used the same type of instrument (KC 10). For 10 consecutive days, they determined PTS on a normal plasma pool, plasma dilutions of 1/2, 1/3 and 1/8, 3 identical lyophilized calibrated plasmas, as well as plasmas from 20 normal subjects, 50 patients on oral anticoagulant therapy with Recombiplastin which has an International Sensitivity Index (ISI) of 1, and 2 commercial thromboplastin extracts (ISI #1 or 2). In the patients on anticoagulants, factors VII, X and V were measured when results were conflicting.The intra and interlaboratory reproducibilities of Recombiplastin, calculated on the basis of either PTS expressed in seconds, or of the International Normalized Ratio (INR), were good, with coefficients of variation (CV) similar to those observed with the 5 other reagents used by the different laboratories (2% <CV <8%).The stability of Recombiplastin was excellent, with no variation in PT after 72 h of incubation at 37° C.A normal PT of 12 s was obtained with Recombiplastin, similar to the values found for the reagents with ISI #2. In the patients on anticoagulants, Recombiplastin gave the longest coagulation times (PTRecombipiastin = 64.2 s vs PTNeoPlastin = 32.8 s, and PTThromborel = 54.4 s). These results suggest that Recombiplastin is highly sensitive to the changes in coagulation induced by anticoagulants. Recombiplastin was more sensitive to factor VII deficiency than any of the other reagents, even those with ISI #1.The coefficients of correlation between the INRS calculated on the basis of the PTS obtained with Recombiplastin and the INRS based on the PTS for other thromboplastins, were satisfactory (0.85 <R <0.95) but a breakpoint in the slope of the regression curves was observed when INR >4. This observation requires further investigation, particularly in connection with the exact ISI values for Recombiplastin and the other thromboplastins used in this study.In conclusion, Recombiplastin is stable and sensitive and gives accurate reproducible results. However, the behavior of Recombiplastin is slightly different from that of the commercial reagents whether their ISI is 1 or 2, and its use did not reduce the interlaboratory dispersion of PT values.

Recombinant Tissue Factor as Substitute for Conventional Thromboplastin in the Prothrombin Time Test

1992 ◽  
Vol 67 (01) ◽  
pp. 042-045 ◽  
Author(s):  
Armando Tripodi ◽  
Arnaldo Arbini ◽  
Veena Chantarangkul ◽  
Pier Mannuccio Mannucci
Keyword(s):  
Prothrombin Time ◽  
Tissue Factor ◽  
Oral Anticoagulant Therapy ◽  
Clotting Factor ◽  
Rabbit Brain ◽  
Sensitivity Index ◽  
Clotting Factors ◽  
Wide Range ◽  
Reference Preparation ◽  
Time Test

SummaryRelipidated recombinant tissue factor (r-TF) has been assessed in comparison with conventional rabbit brain thromboplastin (Manchester Reagent) for its suitability for measurement of prothrombin time (PT). The International Sensitivity Index (ISI) of r-TF calibrated against the International Reference Preparation BCT/253 (human plain) was found to be 0.96 and 1.12 with instrumental and manual techniques. Our study of plasmas from patients with congenital deficiencies of clotting factors covering a wide range of severity demonstrates that r-TF is able to detect even minor deficiencies of factors involved in the extrinsic and common coagulation pathways. Patients with liver diseases were correctly diagnosed with a prevalence of abnormal results comparable for both reagents. Between-assay reproducibility expressed as coefficient of variation was 2.3 % and 3.9 % at normal and abnormal PT levels.In conclusion, our evaluation shows that relipidated r-TF possesses the necessary requisites of sensitivity, diagnostic accuracy and reproducibility which make it a suitable candidate for PT determination both for monitoring oral anticoagulant therapy and diagnosing congenital and acquired clotting factor deficiencies. Moreover, being a highly defined reagent it may constitute a step forward in the standardization of PT testing.

scholarly journals Compliance with and awareness about long-term oral anticoagulant therapy among Saudi patients in a University Hospital, Riyadh, Saudi Arabia

2016 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
NervanaM. K Bayoumy ◽  
ShehanahFahad Al-Omair ◽  
NorahAhmed Musallam ◽  
NoraYazid Al-Deghaither ◽  
NoufAbdulwahab Al-Sadoun
Keyword(s):  
Saudi Arabia ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
University Hospital ◽  
Saudi Patients

scholarly journals Comparison of the native prothrombin antigen and the prothrombin time for monitoring oral anticoagulant therapy

Blood ◽  
1984 ◽  
Vol 64 (2) ◽  
pp. 445-451 ◽  
Author(s):  
B Furie ◽  
HA Liebman ◽  
RA Blanchard ◽  
MS Coleman ◽  
SF Kruger ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Warfarin Therapy ◽  
Oral Anticoagulant Therapy ◽  
Bleeding Complications ◽  
Thromboembolic Complications ◽  
Serum Samples ◽  
Time Index ◽  
Patients At Risk

Abstract We have measured the fully carboxylated (native) prothrombin antigen and the undercarboxylated (abnormal) prothrombin antigen in patients treated with sodium warfarin using specific immunoassays to evaluate a new approach for monitoring oral anticoagulant therapy. Plasma and serum samples (391) were assayed for the prothrombin time, native prothrombin antigen, and abnormal prothrombin antigen. The results were correlated with the presence of bleeding or thromboembolic complications at the time of phlebotomy. The native prothrombin antigen correlated with the occurrence of complications in 95% of samples. Of 13 samples from patients with bleeding complications, 13/13 (100%) had a native prothrombin of 12 micrograms/mL or lower. Of seven samples from patients with thromboembolic complications, 6/7 (86%) had a native prothrombin of 24 micrograms/mL or greater. By comparison, a prothrombin time index of 1.5 to 2.5, 1.5 to 2.2, 1.5 to 2.0, or 1.3 to 1.8 identified 6/20 (30%), 9/20 (45%), 11/20 (55%), or 12/20 (60%) patients at risk, respectively. Although the prothrombin time index did correlate with the presence of bleeding complications, the native prothrombin antigen correlated closely with the presence of bleeding and thromboembolic complications. According to these results, the native prothrombin antigen, maintained in a range of 12 to 24 micrograms/mL by regular adjustment of the warfarin dosage, may be associated with a reduced risk of complications due to excessive or insufficient warfarin therapy. On the basis of these preliminary data, we recommend that the native prothrombin antigen be considered to monitor warfarin therapy.

Fluorogenic Assays for Functional Factor VIIa and Tissue Factor.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1740-1740
Author(s):  
Sara J. Ethier ◽  
Saulius Butenas ◽  
Richard J. Jenny
Keyword(s):  
Tissue Factor ◽  
Specific Activity ◽  
Factor Viia ◽  
Factor Vii ◽  
Assay Method ◽  
Sensitivity Index ◽  
Functional Assay ◽  
Plasma Samples ◽  
Functional Basis

Abstract Blood coagulation is initiated when cryptic tissue factor (TF) becomes exposed on the surface of vascular cells where it can bind circulating factor VIIa (fVIIa). The resulting fVIIa/TF enzyme complex catalyzes the activation of certain blood zymogens that propagate the coagulation event. As a key enzyme for the initiation of coagulation, circulating fVIIa levels have been viewed as an indicator of hemostatic potential and may also be an indicator for the risk of developing cardiovascular disease. The formation of the fVIIa/TF complex is also the basis of specific coagulation assays. Natural or synthetic TF is employed in the prothrombin time (PT assay) where it is used to initiate coagulation in vitro. Therefore, fVIIa and TF play important roles both in vivo and in vitro. Despite such important roles, there have been no simple methods described for measuring the active forms of either protein. This report describes the initial development of an assay for fVIIa and TF that employs the use of an Aminonaphthalenesulfonamide-based (ANSN) fluorogenic substrate. The ANSN substrate is hydrolyzed by fVIIa in a TF-dependent manner, and by titrating fVIIa into a system containing excess TF, the assay becomes sensitive to the fVIIa concentration. Inversely, by titrating TF into a system containing excess fVIIa, the assay becomes sensitive to the TF concentration. This approach has led to the development of both a rapid kinetic and an end-point assay method for each analyte providing detection ranges down to 156 and 1.56 pM respectively. The utility of these assays is displayed by the following applications. Thromboplastin reagents are generally qualified against a W.H.O. standard and are assigned a numerical value known as the International Sensitivity Index (ISI). Theoretically the ISI value should be affected by the quantity and quality of TF in each preparation. An inverse relationship between ISI value and the amount of functional TF would support this theory. To prove this relationship the TF assay was employed to examine two thromboplastin reagents with ISI values of 1.84 and 1.01. The concentration of functional TF measured by this assay was 10.8 nM and 14.6 nM respectively. Because most commercial thromboplastin reagents are prepared by adding TF on a mass basis (as opposed to a functional basis), target ISI values are often missed, leading to an excessive number of failed lots. The TF functional assay provides a method for assigning a specific activity to each TF preparation. By adding TF on a functional basis, lot-to-lot variability would be minimized and target ISI values would be easily achieved. To substantiate this claim, we have determined the functional activity of seven different lots of purified recombinant human TF. With each lot analyzed at a fixed concentration, we observed a broad range of specific activity (range: 8,250 U/sec/mg -14,500 U/sec/mg). These data support the need for a functional TF assay to be incorporated in the manufacturing process of thromboplastin reagents. Lastly, the utility of the fVIIa assay was demonstrated in an experiment using factor VII-deficient plasma samples that were spiked with known quantities of fVIIa. Plasma samples spiked with fVIIa in the range of 0.5-2nM returned mean assay values within 71–100% of the expected values. These data demonstrate the feasibility of using the fVIIa assay to monitor fVIIa levels in hemophilia patients receiving recombinant fVIIa therapy. Further studies will address the circulating concentrations of fVIIa and TF in “normal” and disease state plasma samples.

scholarly journals Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study

2011 ◽  
Vol 5 (1) ◽  
Author(s):  
Francesco Inchingolo ◽  
Marco Tatullo ◽  
Fabio M Abenavoli ◽  
Massimo Marrelli ◽  
Alessio D Inchingolo ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Multicentric Study

Multicentric Evaluation of a New PT Reagent Based on Recombinant Human Tissue Factor and Synthetic Phospholipids

1994 ◽  
Vol 71 (03) ◽  
pp. 292-299 ◽  
Author(s):  
R Bader ◽  
P M M Mannucci ◽  
A Tripodi ◽  
J Hirsh ◽  
F Keller ◽  
...  
Keyword(s):  
Tissue Factor ◽  
Human Tissue ◽  
Regression Line ◽  
Coagulation Factor ◽  
Phosphatidyl Serine ◽  
Factor Vii ◽  
Rabbit Brain ◽  
Sensitivity Index ◽  
Mean Values ◽  
Automated Instrument

SummaryA new PT reagent based on recombinant human tissue factor and synthetic phospholipids (phosphatidyl choline and phosphatidyl serine) with defined fatty acid side chains was calibrated against BCT/253 and CRM 149R. A small but consistent bias in the International Sensitivity Index (ISI) value was obtained using either the human or rabbit brain reference material. ISI values were around 1.0 or slightly lower depending on the respective instrument. Mixing studies with factor deficient plasmas showed a high factor sensitivity especially for factor VII as compared to commercial rabbit brain or human placenta thromboplastin. In an international field trial the reagent was tested using fully or semi automated Electra™ coagulometers in 4 different laboratories. Results with normal samples were in excellent agreement among the different laboratories. Mean values were 10.9, 10.9, 11.0, 11,7 s with a range of 9.5 to 12.5 s. Results of males and females were not different. In patients with liver disease very similar PT activities were found as compared to sensitive rabbit brain or human placental thromboplastins. In normals and patients with oral anticoagulation INR values correlated very well against BCT (r = 0.98, regression line y =-0.07 + 0.9 x). The distribution of samples was linear over the whole range. In the comparison against sensitive rabbit brain thromboplastin or human placental thromboplastin similar correlations were found. In a few cases higher INR values were observed for the recombinant reagent especially in patients with intensive treatment. Factor assays in those patients showed at least the strong reduction of one vitamin Independent coagulation factor. Over all the linearity was better against the rabbit brain reagent than against the human placental reagent which is slightly less factor VII sensitive as shown in mixing studies with normal and factor VII deficient plasma. Precision studies in the 4 laboratories showed excellent reproducibility of lyophilised controls or local patient plasma pools for all reagents with a better performance of the recombinant reagent. C. V. values from day to day ranged from 1.3% to 5% for normal and abnormal controls.These results show that the recombinant PT reagent, especially in conjunction with a precise automated instrument, may improve the results of PT testing and thus may lead to better patient care.

Oral Anticoagulant Therapy Control: Evidence that INR Expression Improves the Inter-Laboratory Comparability of Results - The Bologna Oral Anticoagulant Control Exercise

1987 ◽  
Vol 58 (03) ◽  
pp. 905-910 ◽  
Author(s):  
G Palareti ◽  
S Coccheri ◽  
M Poggi ◽  
M Bonetti ◽  
V Cervi ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Normal Subjects ◽  
International Normalized Ratio ◽  
Sensitivity Index ◽  
Therapy Control ◽  
Educational Value ◽  
International Reference ◽  
Interlaboratory Variability

SummaryThe aims of the present study were: l) interlaboratory normalization of prothrombin time (PT) testing for anticoagulant therapy control through calibration of customary thromboplastins against international reference materials, and 2) “on field” validation of the advantages offered by expression of results as International Normalized Ratio (INR) as opposedto percentage activity. PT tests were carried out over 8 days on the same normal subjects (16) and patients on oral an ticoagulants (48) in the 9 laboratories of the Bologna area. The use of customary thromboplastins and coagulometers was maintained in all labs throughout the study. The main results were: 1) the interlaboratory CV of the prothrombin ratios obtained for each sample with all customary thromboplastins (5 different brands) was 15%, but was reduced to levels of 5.8 to 8.9 when using constant thromboplastin brands and batches; 2) the International Sensitivity Index (ISI) values obtained in the different labs were only slightly influenced by the use of different coagulometers; 3) comparable ISI values were obtained through direct calibration with the international reference material and through intermediate calibration with a locally selected standard; 4) use of INR values instead of percentage activity greatly reduced interlaboratory variability and significantly improved uniformity of anticoagulation level measurements. thus reducing the possibility of erroneous prescriptions. The Bologna exercise is therefore of educational value for laboratory and community doctors of the area in understanding and accepting the INR system.

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