Point of care measurement of lepirudin and heparin anticoagulation during systemic inflammation.

Abstract

BACKGROUND:

The number of indications for recombinant human hirudin lepirudin therapy has increased in recent years, and now includes acute coronary syndromes and heparin-induced thrombocytopenia. Hence, point of care monitoring appears desirable for therapy with lepirudin. As CoaguChek Plus (CCP) provides a rapid bedside test to monitor therapy with other anticoagulants, we aimed to determine its suitability for lepirudin therapy.

METHODS:

Forty-four healthy volunteers received a 2 ng/kg endotoxin infusion (to induce coagulation) together with clinically relevant doses of lepirudin or heparin in a prospective, placebo-controlled, randomised fashion. Measurements of CCP-partial thromboplastin time (aPTT) were compared to laboratory STA-aPTT.

RESULTS:

As expected, baseline values of CCP-aPTT were shorter than STA-aPTT. Lepirudin increased CCP-aPTT 3-fold, and STA-aPTT 2-fold 1 h after bolus infusion. During lepirudin infusion, the correlation between CCP-aPTT and STA-aPTT was excellent (r=0.86-0.92). Both methods were equally sensitive to over-anticoagulation with heparin. Acute systemic inflammation had little effects on CCP-aPTT.

CONCLUSION:

CCP-aPTT is suitable for longitudinal point of care monitoring of lepirudin therapy. As baseline values of CCP-aPTT are shorter than STA-aPTT, it is recommended not to indiscriminately change between methods in the follow-up of individual patients.

• Authors: Monika Homoncik, Thomas Pernerstorfer, Rosemarie Reiter, Maarten Knechtelsdorfer, Peter Quehenberger, Bernd Jilma
• Journal: Thrombosis research (Thromb Res) Vol. 108 Issue 1 Pg. 91-5 (Oct 01 2002) ISSN: 0049-3848 [Print] United States
• PMID: 12586138 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Hirudins
• Lipopolysaccharides
• Recombinant Proteins
• Heparin
• lepirudin

Topics

• Adult
• Anticoagulants (therapeutic use)
• Blood Coagulation (drug effects)
• Blood Coagulation Tests (methods, statistics & numerical data)
• Heparin (therapeutic use)
• Hirudins (analogs & derivatives)
• Humans
• Inflammation (blood, drug therapy)
• Lipopolysaccharides (administration & dosage)
• Male
• Partial Thromboplastin Time
• Point-of-Care Systems (statistics & numerical data)
• Prospective Studies
• Recombinant Proteins (therapeutic use)
• Sensitivity and Specificity