PDF(Pubmed)
Abstract：
In patients who require systemic anticoagulation, a reliable monitoring method is required to ensure anticoagulation is maintained within the correct therapeutic window and patients are treated appropriately. When titrating direct thrombin inhibitors (DTIs), dilute thrombin time (dTT) measurements have been demonstrated to be more reliable and accurate than activated partial thromboplastin time (aPTT) measurements and thus often the preferred DTI assessment. However, a clinical need arises when both dTT measurements are not readily available and aPTT measurements are unreliable.
METHODS: A 57-year-old woman with a history of antiphospholipid antibody syndrome, heparin-induced thrombocytopenia, and multiple prior deep venous thromboses and pulmonary emboli was admitted with COVID-19 pneumonia and intubated due to hypoxic respiratory failure. Argatroban was initiated in place of her home medication warfarin. However, the patient had a prolonged aPTT value at baseline and overnight dTT assay measurements were limited at our institution. A multidisciplinary team of hematology and pharmacy clinicians created a modified patient-specific aPTT target range and argatroban dosing was titrated accordingly. Subsequent aPTT values in the modified target range corresponded to therapeutic dTT values, indicating therapeutic anticoagulation was successfully achieved and maintained. Patient blood samples were additionally evaluated retrospectively using an investigational novel point-of-care test that detected and quantified the argatroban anticoagulant effect.
CONCLUSIONS: Therapeutic anticoagulation with a DTI in a patient with unreliable aPTT measurements can be achieved with use of a modified patient-specific aPTT target range. Early validation of an investigational rapid testing alternative for DTI monitoring is promising.
METHODS: A 57-year-old woman with a history of antiphospholipid antibody syndrome, heparin-induced thrombocytopenia, and multiple prior deep venous thromboses and pulmonary emboli was admitted with COVID-19 pneumonia and intubated due to hypoxic respiratory failure. Argatroban was initiated in place of her home medication warfarin. However, the patient had a prolonged aPTT value at baseline and overnight dTT assay measurements were limited at our institution. A multidisciplinary team of hematology and pharmacy clinicians created a modified patient-specific aPTT target range and argatroban dosing was titrated accordingly. Subsequent aPTT values in the modified target range corresponded to therapeutic dTT values, indicating therapeutic anticoagulation was successfully achieved and maintained. Patient blood samples were additionally evaluated retrospectively using an investigational novel point-of-care test that detected and quantified the argatroban anticoagulant effect.
CONCLUSIONS: Therapeutic anticoagulation with a DTI in a patient with unreliable aPTT measurements can be achieved with use of a modified patient-specific aPTT target range. Early validation of an investigational rapid testing alternative for DTI monitoring is promising.
摘要：
在需要全身抗凝的患者中，需要可靠的监测方法,以确保抗凝药物维持在正确的治疗窗口内,并且患者得到适当的治疗.当滴定直接凝血酶抑制剂（DTIs）时，已证明稀释凝血酶时间(dTT)测量比活化部分凝血活酶时间(aPTT)测量更可靠和准确,因此通常是首选的DTI评估.然而,当两种dTT测量都不容易获得并且aPTT测量不可靠时,就会出现临床需要.
方法：一名57岁女性，有抗磷脂抗体综合征病史，肝素诱导的血小板减少症,先前多次深静脉血栓形成和肺栓塞因COVID-19肺炎入院，并因低氧性呼吸衰竭插管。开始使用Argatroban代替她的家庭药物华法林。然而,患者在基线时的aPTT值延长,我们机构的dTT分析测量值有限.一个多学科的血液学和药学临床医生团队创建了修改的患者特异性aPTT目标范围，并相应地滴定了阿加曲班剂量。修改后的目标范围内的后续aPTT值对应于治疗性dTT值，表明治疗性抗凝治疗已成功实现并维持。另外,使用检测和定量阿加曲班抗凝作用的研究性新型护理点测试对患者血液样本进行回顾性评估。
结论：在aPTT测量结果不可靠的患者中使用DTI的治疗性抗凝可以通过使用修改的患者特异性aPTT目标范围来实现。DTI监测的研究性快速测试替代方案的早期验证是有希望的。
方法：一名57岁女性，有抗磷脂抗体综合征病史，肝素诱导的血小板减少症,先前多次深静脉血栓形成和肺栓塞因COVID-19肺炎入院，并因低氧性呼吸衰竭插管。开始使用Argatroban代替她的家庭药物华法林。然而,患者在基线时的aPTT值延长,我们机构的dTT分析测量值有限.一个多学科的血液学和药学临床医生团队创建了修改的患者特异性aPTT目标范围，并相应地滴定了阿加曲班剂量。修改后的目标范围内的后续aPTT值对应于治疗性dTT值，表明治疗性抗凝治疗已成功实现并维持。另外,使用检测和定量阿加曲班抗凝作用的研究性新型护理点测试对患者血液样本进行回顾性评估。
结论：在aPTT测量结果不可靠的患者中使用DTI的治疗性抗凝可以通过使用修改的患者特异性aPTT目标范围来实现。DTI监测的研究性快速测试替代方案的早期验证是有希望的。
