Circuit Life Versus Bleeding Risk: The Impact of Achieved Activated Partial Thromboplastin Time Versus Achieved Filtration Fraction

2014 ◽  
Vol 19 (3) ◽  
pp. 259-266 ◽  
Author(s):  
Clare MacEwen ◽  
Peter Watkinson ◽  
Christopher Winearls
Keyword(s):  
Partial Thromboplastin Time ◽  
Bleeding Risk ◽  
Activated Partial Thromboplastin Time ◽  
Filtration Fraction ◽  
The Impact

Long-term safety outcomes of prekallikrein (Fletcher factor) deficiency: A systematic literature review of case reports

2020 ◽  
Vol 41 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Antonio Girolami ◽  
Catherine Rolland ◽  
Dan Sexton ◽  
Moshe Vardi ◽  
Jonathan A. Bernstein
Keyword(s):  
Lupus Erythematosus ◽  
Partial Thromboplastin Time ◽  
Case Reports ◽  
Activated Partial Thromboplastin Time ◽  
Plasma Kallikrein ◽  
Time Data ◽  
Factor Deficiency ◽  
Fletcher Factor ◽  
The Impact

Background: Hereditary prekallikrein (Fletcher factor) deficiency is a rare condition characterized by a prolonged activated partial thromboplastin time. Inhibitors of plasma kallikrein have recently been approved for prophylaxis of hereditary angioedema and are under investigation for use in other indications. Objective: We attempted to conservatively assess the impact of long-term inhibition of this pathway by reviewing reported comorbidities in patients with hereditary prekallikrein deficiency. Methods: We searched several medical literature databases for publications that reported data from patients with hereditary prekallikrein deficiency (<10% of normal and/or shortening of activated partial thromboplastin time on increased incubation time). Data reporting of cardiovascular, bleeding, and autoimmune-related diseases were extracted. Results: Of 1966 publications screened, 45 publications (which represented 53 patients with prekallikrein deficiency) were included. Among 53 identified patients with prekallikrein deficiency, 25 were explicitly defined as asymptomatic, with no comorbidities mentioned in another three cases. Another 16 of the 53 patients were described as having undergone surgery or dental extractions with no complications. Cardiovascular comorbidities were reported in 19 patients, mainly hypertension (9 patients) and cerebrovascular ischemia or stroke (5 patients). Excessive bleeding episodes after surgery were reported in four patients. Autoimmune-related diseases were reported for three patients (two with Graves disease and one with systemic lupus erythematosus). Conclusion: This review identified patients with hereditary prekallikrein deficiency who reported a spectrum of health outcomes from asymptomatic to infrequent reports of cardiovascular, bleeding, and autoimmune comorbidities. The majority of the reports did not indicate any association between prekallikrein deficiency and comorbidities; however, additional observation is required to confirm the long-term safety of plasma kallikrein inhibition.

scholarly journals Plasma prothrombin time and activated partial thromboplastin time as predictors of bleeding manifestations during dengue hemorrhagic fever

2009 ◽  
Vol 49 (2) ◽  
pp. 69
Author(s):  
I. N. Budastra ◽  
B. N. P. Arhana ◽  
IB. Mudita
Keyword(s):  
Cohort Study ◽  
Partial Thromboplastin Time ◽  
Cox Regression ◽  
Hemorrhagic Fever ◽  
Massive Bleeding ◽  
Activated Partial Thromboplastin Time ◽  
Regression Analyses ◽  
Cox Regression Analysis ◽  
The Impact ◽  
The Relationship

Background  Massive bleeding and shock are complications  ofdengue  hemorrhagic  fever (DHF)  that  are associated withhigh mortality. Impaired hemostasis, especially coagulopathy,contributes  to  bleeding manifestations in DHF. Parameters suchas  activated partial thromboplastin time (APTT)  and  plasmaprothrombin  time (PPT) indicate  the  impact  of  coagulationsystem.Objective  To  determine the relationship between  APTT  and PPTlevels with bleeding manifestations in  DHF  patients.Methods  A prospective  cohort  study was applied to subjectsdiagnosed with  DHF  at  the  Infection  and  Tropical DiseasesDivision, Department  of  Child Health, Medical School, UdayanaUniversity, Sanglah Hospital, Denpasar, Indonesia. Laboratorytests  to  determine  APTT  and  PPT  were carried  out  on  thethird, fourth,  and  fifth day after  the  onset  of  fever. Bleedingmanifestations were examined in patients during their hospitalstay. Univariate  and  Cox regression analyses were performedto examine relationship between  APTT  and  PPT  values withbleeding manifestations in  DHF  patients.Results  Forty-three children were enrolled in this study.  Therewas a significant relationship between increases in  APTT  valuewith bleeding manifestations in  DHF  patients [RR 2.79 (95%CI1.68 to 4.69), P <0.01]. Cox regression analysis showed  that  onlyincreased  APTT  values correlated with bleeding manifestations[RR 2.05 (95%CI 1.92 to 3.90), P  =  0.02].Conclusion  APTT  values may be used  as  a predictor for bleedingmanifestations  in  DHF.

scholarly journals Update on the Clot Waveform Analysis

2020 ◽  
Vol 26 ◽  
pp. 107602962091202
Author(s):  
Hideo Wada ◽  
Takeshi Matsumoto ◽  
Kohshi Ohishi ◽  
Katsuya Shiraki ◽  
Motomu Shimaoka
Keyword(s):  
Differential Diagnosis ◽  
Partial Thromboplastin Time ◽  
Coagulation Factor ◽  
Bleeding Risk ◽  
Activated Partial Thromboplastin Time ◽  
Waveform Analysis ◽  
Factor Viii Activity ◽  
Factor Deficiency ◽  
Coagulation Factor Deficiency ◽  
Low Levels

The activated partial thromboplastin time (APTT)–clot waveform analysis (CWA) was previously reported to be associated with the early detection of disseminated intravascular coagulation and was also reported to be able to measure very low levels of coagulation factor VIII activity. The software program for the analysis for the APTT-CWA allows the associated first and second derivative curves (first and second DCs) to be displayed. The first and second DC reflect the velocity and acceleration, respectively. The height of the first DC reflects the “thrombin burst” and bleeding risk, while that of the second DC is useful for detecting any coagulation factor deficiency and abnormal enhancement of coagulation by phospholipids. Activated partial thromboplastin time-CWA aids in making a differential diagnosis which is difficult to do using only the routine APTT. The CWA is currently used for many applications in the clinical setting, including the monitoring of hemophilia patients and patients receiving anticoagulant therapy and the differential diagnosis of diseases.

Long-term safety outcomes of prekillikrein (Fletcher factor) deficiency: A systematic literature review of case reports

2019 ◽  
Author(s):  
Antonio Girolami ◽  
Catherine Rolland ◽  
Dan Sexton ◽  
Moshe Vardi ◽  
Jonathan A. Bernstein
Keyword(s):  
Lupus Erythematosus ◽  
Partial Thromboplastin Time ◽  
Case Reports ◽  
Activated Partial Thromboplastin Time ◽  
Plasma Kallikrein ◽  
Excessive Bleeding ◽  
Factor Deficiency ◽  
Fletcher Factor ◽  
The Impact

Background: Hereditary prekallikrein (Fletcher factor) deficiency is a rare condition characterized by a prolonged activated partial thromboplastin time. Inhibitors of plasma kallikrein have recently been approved for prophylaxis of hereditary angioedema and are under investigation for use in other indications.Objective: We attempted to conservatively assess the impact of long-term inhibition of this pathway by reviewing reportedcomorbidities in patients with hereditary prekallikrein deficiency.Methods: We searched several medical literature databases for publications that reported data from patients with hereditaryprekallikrein deficiency (<10% of normal and/or shortening of activated partial thromboplastin time on increased incubationtime). Data reporting of cardiovascular, bleeding, and autoimmune-related diseases were extracted.Results: Of 1966 publications screened, 45 publications (which represented 53 patients with prekallikrein deficiency) wereincluded. Among 53 identified patients with prekallikrein deficiency, 25 were explicitly defined as asymptomatic, with no comorbidities mentioned in another three cases. Another 16 of the 53 patients were described as having undergone surgery or dental extractions with no complications. Cardiovascular comorbidities were reported in 19 patients, mainly hypertension (9 patients) and cerebrovascular ischemia or stroke (5 patients). Excessive bleeding episodes after surgery were reported in four patients. Autoimmune-related diseases were reported for three patients (two with Graves disease and onewith systemic lupus erythematosus).Conclusion: This review identified patients with hereditary prekallikrein deficiency who reported a spectrum of health outcomes from asymptomatic to infrequent reports of cardiovascular, bleeding, and autoimmune comorbidities. The majority of the reports did not indicate any association between prekallikrein deficiency and comorbidities; however, additional observation is required to confirm the long-term safety of plasma kallikrein inhibition.

Influence of Yoga on Blood Coagulation

1984 ◽  
Vol 51 (02) ◽  
pp. 196-197 ◽  
Author(s):  
I S Chohan ◽  
H S Nayar ◽  
P Thomas ◽  
N S Geetha
Keyword(s):  
Platelet Aggregation ◽  
Blood Coagulation ◽  
Partial Thromboplastin Time ◽  
Fibrinolytic Activity ◽  
Activated Partial Thromboplastin Time ◽  
Mental Functions ◽  
Beneficial Effects ◽  
Before And After ◽  
The Impact

SummaryYoga is known to induce beneficial effects on physiological, biochemical and mental functions in man. Its effects on blood coagulation are not known. A study was conducted in seven previously untrained male adults who underwent a combination of yogic exercises, daily for one hour, over a period of four months. Parameters of blood coagulation were estimated before and after the end of yoga training. The following changes were observed: Fibrinolytic activity increased significantly with a concomitant fall in fibrinogen; activated partial thromboplastin time and platelet aggregation time were prolonged; blood and plasma platelets showed a rise; and both haemoglobin and heamatocrit were raised at the end of the training.These findings suggest that yoga induces a state of blood hypocoagulability. The impact of yoga on prevention of cardiovascular and thrombotic disorders is obvious.

Different Heparin Lots

2001 ◽  
Vol 125 (11) ◽  
pp. 1458-1462
Author(s):  
Maureen A. Smythe ◽  
John M. Koerber ◽  
Susan J. Westley ◽  
Mamtha Balasubramaniam ◽  
Joan C. Mattson
Keyword(s):  
Retrospective Analysis ◽  
Outcome Measures ◽  
Therapeutic Range ◽  
Partial Thromboplastin Time ◽  
Factor Xa ◽  
Activated Partial Thromboplastin Time ◽  
Teaching Institution ◽  
Standard Curve ◽  
Heparin Concentration ◽  
The Impact

Abstract Objective.—To assess the impact of heparin lot on the correlation between heparin concentration and activated partial thromboplastin time (aPTT), the aPTT therapeutic range, and the heparin level. Design.—Retrospective analysis of data from 2 previous studies. Setting.—Teaching institution with 929 beds. Patients.—Ninety-five patients receiving heparin with 5 different lots (study 1) and 35 patients receiving heparin with 3 different lots (study 2). Main Outcome Measures.—Laboratory-based aPTT and heparin level by anti-factor Xa analysis. Standard heparin curves were created for each lot. Each patient's heparin level was determined off each standard curve. Results.—Correlations between heparin concentration and aPTT ranged from 0.87 to 0.89 (study 1) and 0.86 to 0.87 (study 2). Slopes of regression lines were not significantly different. Therapeutic ranges generated from lot-specific heparin levels were similar. Average bias in heparin levels from varying lots ranged from 0.005 to 0.036 units/mL. Conclusions.—The recommendation to reevaluate the aPTT therapeutic range with each new lot of heparin requires further evaluation.

Monitoring Heparin Therapy: Relationships between the Activated Partial Thromboplastin Time and Heparin Assays Based on Ex-Vivo Heparin Samples

1990 ◽  
Vol 63 (01) ◽  
pp. 016-023 ◽  
Author(s):  
A M H P van den Bessekaar ◽  
J Meeuwisse-Braun ◽  
R M Bertina
Keyword(s):  
Partial Thromboplastin Time ◽  
Plasma Sample ◽  
Ex Vivo ◽  
Correlation Coefficients ◽  
Heparin Therapy ◽  
Thromboembolic Disease ◽  
Activated Partial Thromboplastin Time ◽  
Venous Thromboembolic Disease ◽  
Venous Thromboembolic

SummaryFive different APTT reagents, two amidolytic anti-ITa assays, one amidoiytic anti-Xa assay, and one coagulometric anti-Xa/ anti-IIa assay were used to assess the effect of heparin in patients treated for venous thromboembolic disease. Good correlations were observed between lug-transformed APYE> determined with the various reagents (correlation coefficients: 0.92-0.96).Nevertheless there were important differences in the slopes of the lines of relationship between the APTT reagents.Good correlations were observed between the anti-Xa and anti-IIa assay results (correlation coefficients: 0.92-0.97). However, the amidolytic anti-Xa activity was significantly higher (p <0.001) than the two amidolytic anti-IIa activities. Less good correlations were observed between the log-transformed APTTs and the anti-Xa or anti-IIa activities (correlation coefficients: 0.64-0.78). The correlations were improved by transforming the APTT into APTT-ratio, i.e. the ratio of the patient’s APTT to the same patient’s APTT after removal of heparin from the plasma sample by means of ECTEOLA-cellulose treatment. The correlation coefficients of log (AFTT-ratio) with anti-Xa or anti-IIa ranged from 0.76 to 0.87.For both APTT and amidolytic heparin assay, the response to in vitro heparin was different from the response to ex vivo heparin.Therefore, equivalent therapeutic ranges should be assessed by using ex vivo samples rather than in vitro heparin. Because of the response differences between the APTT reagents, it is not adequate to define a therapeutic range for heparin therapy without specification of the reagent.

Monitoring Anticoagulant Therapy by Activated Partial Thromboplastin Time: Hirudin Assessment

1994 ◽  
Vol 72 (05) ◽  
pp. 685-692 ◽  
Author(s):  
Michael T Nurmohamed ◽  
René J Berckmans ◽  
Willy M Morriën-Salomons ◽  
Fenny Berends ◽  
Daan W Hommes ◽  
...  
Keyword(s):  
Whole Blood ◽  
Partial Thromboplastin Time ◽  
Ex Vivo ◽  
Fold Increase ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Recombinant Hirudin ◽  
Interindividual Differences ◽  
The Relationship

SummaryBackground. Recombinant hirudin (RH) is a new anticoagulant for prophylaxis and treatment of venous and arterial thrombosis. To which extent the activated partial thromboplastin time (APTT) is suitable for monitoring of RH has not been properly evaluated. Recently, a capillary whole blood device was developed for bed-side monitoring of the APTT and it was demonstrated that this device was suitable to monitor heparin therapy. However, monitoring of RH was not evaluated.Study Objectives. To evaluate in vitro and ex vivo the responsiveness and reproducibility for hirudin monitoring of the whole blood monitor and of plasma APTT assays, which were performed with several reagents and two conventional coagulometers.Results. Large interindividual differences in hirudin responsiveness were noted in both the in vitro and the ex vivo experiments. The relationship between the APTT, expressed as clotting time or ratio of initial and prolonged APTT, and the hirudin concentration was nonlinear. A 1.5-fold increase of the clotting times was obtained at 150-200 ng/ml plasma. However, only a 2-fold increase was obtained at hirudin levels varying from 300 ng to more than 750 ng RH/ml plasma regardless of the assays. The relationship linearized upon logarithmic conversion of the ratio and the hirudin concentration. Disregarding the interindividual differences, and presuming full linearity of the relationship, all combinations were equally responsive to hirudin.Conclusions. All assays were equally responsive to hirudin. Levels up to 300 ng/ml plasma can be reliably estimated with each assay. The manual device may be preferable in situations where rapid availability of test results is necessary.

In Vitro Thrombogenicity Tests of Factor IX Concentrates

1979 ◽  
Vol 42 (05) ◽  
pp. 1355-1367 ◽  
Author(s):  
C V Prowse ◽  
A Chirnside ◽  
R A Elton
Keyword(s):  
Factor Viii ◽  
Partial Thromboplastin Time ◽  
Generation Time ◽  
Activated Partial Thromboplastin Time ◽  
Factor Ix ◽  
In Vitro Tests ◽  
Factor Viii Inhibitor ◽  
Factor Ixa ◽  
Viii Inhibitor

SummaryVarious factor IX concentrates have been examined in a number of in vitro tests of thrombogenicity. The results suggest that some tests are superfluous as in concentrates with activity in any of these tests activation is revealed by a combination of the non-activated partial thromboplastin time, the thrombin (or Xa) generation time and factor VIII inhibitor bypassing activity tests. Assay of individual coagulant enzymes revealed that most concentrates contained more factor IXa than Xa. However only a small number of concentrates, chiefly those that had been purposefully activated, contained appreciable amounts of either enzyme.

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