单独的标准凝血测定不足以排除与手术相关的利伐沙班血浆浓度,Perioperative Medicine

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单独的标准凝血测定不足以排除与手术相关的利伐沙班血浆浓度
Perioperative Medicine ( IF 2.0 ) Pub Date : 2019-11-20 , DOI: 10.1186/s13741-019-0128-9
Alexander Kaserer , Andreas Schedler , Burkhardt Seifert , Donat R. Spahn , Jan-Dirk Studt , Philipp Stein

背景虽然大型医院已经引入了利伐沙班 (RXA) 的常规抗 Xa 检测，但这些通常依赖于常规凝血测试如凝血酶原时间 (PT) 和活化部分凝血活酶时间 (aPTT) 的小医院并不容易获得。我们的研究旨在研究 RXA 血浆浓度对一大群真实患者的标准凝血测试 PT（快速测试和 INR）和 aPTT 的影响。我们进一步评估了这些标准凝血测定的正常结果是否足以排除与手术相关的 RXA 血浆浓度，定义为 > 50 mcg/l。方法这项回顾性研究包括 2012 年至 2016 年期间抗 Xa（针对 RXA 校准）、PT （快速测试和 INR）和/或 aPTT 是从同一样本中确定的。PT 表示为 Quick 值（正常血浆池的百分比）。总共有 622 名患者的 1027 次测量符合分析条件：505 名患者的 752 次测量为 Quick/INR，417 名患者的 594 次测量为 aPTT。结果 PT/Quick 中度相关（Pearson 相关系数 - 0.59；p < 0.001）观察到 INR（Pearson 相关系数 0.5；p < 0.001）和 aPTT（Pearson 相关系数 0.53；p < 0.001）与 RXA 血浆浓度。然而，在 50% 的 PT/Quick 正常样本、25% 的 INR 正常样本和 80% 的正常 aPTT 残留 RXA 血浆浓度与手术相关。结论尽管 RXA 具有中等相关性观察到 PT/Quick、INR 和 aPTT 的血浆浓度，

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Standard coagulation assays alone are not sufficient to exclude surgically relevant rivaroxaban plasma concentrations

BackgroundWhile mainly larger hospitals have introduced routine anti-Xa assays for rivaroxaban (RXA), these are not readily available to smaller hospitals often relying on routine coagulation tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT).The aim of our study was to investigate the effect of RXA plasma concentration on the standard coagulation tests PT (Quick test and INR) and aPTT in a large group of real-life patients. We further assessed whether normal results of these standard coagulation assays are sufficient to exclude surgically relevant RXA plasma concentration, defined as > 50 mcg/l.MethodsThis retrospective study included all patients between 2012 and 2016 where anti-Xa (calibrated for RXA), PT (Quick test and INR), and/or aPTT were determined from the same sample. PT is expressed as Quick value (% of normal plasma pool). In total, 1027 measurements in 622 patients were eligible for analysis: 752 measurements of 505 patients for Quick/INR and 594 measurements of 417 patients for aPTT.ResultsA moderate correlation of PT/Quick (Pearson's correlation coefficient − 0.59; p < 0.001), INR (Pearson's correlation coefficient 0.5; p < 0.001), and aPTT (Pearson's correlation coefficient 0.53; p < 0.001) with RXA plasma concentration was observed. However, in 50% of all samples with a normal PT/Quick, in 25% of all samples with a normal INR and in 80% of all samples with a normal aPTT residual RXA plasma concentration was surgically relevant.ConclusionAlthough a moderate correlation of RXA plasma concentration with PT/Quick, INR, and aPTT was observed, standard coagulation assays are not sufficient to exclude surgically relevant RXA plasma concentrations.

更新日期：2019-11-20

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