抗凝治疗的实验室监测长城会议.pptVIP

* There are also a number of clinical situations where aPTT monitoring may cause inappropriate dosage increases, and of course, over-coagulation may result in a bleeding episode. The stress associated with a thrombosis can contribute to an acute phase reactant, which will cause an increase in factor VIII and fibrinogen. This will shorten a patient’s aPTT result. This is very common in pregnant women and a cause of in vitro heparin resistance. Further, it is important to note that in thrombotic patients, the larger the thrombosis, the greater amount of heparin required and the harder it is for the patient to come into therapeutic range. Also, centrifugation and conditions of sample storage are important variables. The reason for this is that platelets contain a platelet-specific protein called platelet factor 4, a potent heparin neutralizing protein, and it is released by platelets over time as the sample sits in a test tube. As platelet factor 4 is released, heparin is neutralized and aPTT decreases. The effect of platelet factor 4 can be diminished if samples are centrifuged. If the patient is not responding to heparin therapy, or they constantly have a shortened aPTT, it is very important to measure with the Heparin Anti-Xa Assay, and it’s also worthwhile to get a baseline antithrombin level. Although uncommon, antithrombin deficiency can be a cause of heparin resistance. Some suggest that patients receiving more than 35,000 units of heparin in a 24-hour period may be heparin resistant. * In a 1985 article from the British Medical Journal by Herve DeCousus et al, six patients received weight-based aPTT-adjusted continuous infusion UFH. After giving what was deemed to be the “correct dose”, subsequent aPTT measurements every 4 hours for 48 hours revealed a tremendous inter-and intra-patient variability in aPTT responsiveness on the same fixed dose with no changes in therapy. It’s important to keep in mind that aPTT shows a diurnal variation to a constant inf